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Vascular Parkinsonism: deconstructing a syndrome
#MMPMID25997420
Vizcarra JA
; Lang AE
; Sethi KD
; Espay AJ
Mov Disord
2015[Jun]; 30
(7
): 886-94
PMID25997420
show ga
Progressive ambulatory impairment and abnormal white matter (WM) signal on
neuroimaging come together under the diagnostic umbrella of vascular parkinsonism
(VaP). A critical appraisal of the literature, however, suggests that (1) no
abnormal structural imaging pattern is specific to VaP; (2) there is poor
correlation between brain MRI hyperintensities and microangiopathic brain disease
and parkinsonism from available clinicopathologic data; (3) pure parkinsonism
from vascular injury ("definite" vascular parkinsonism) consistently results from
ischemic or hemorrhagic strokes involving the SN and/or nigrostriatal pathway,
but sparing the striatum itself, the cortex, and the intervening WM; and (4) many
cases reported as VaP may represent pseudovascular parkinsonism (e.g.,
Parkinson's disease or another neurodegenerative parkinsonism, such as PSP with
nonspecific neuroimaging signal abnormalities), vascular pseudoparkinsonism
(e.g., akinetic mutism resulting from bilateral mesial frontal strokes or
apathetic depression from bilateral striatal lacunar strokes), or pseudovascular
pseudoparkinsonism (e.g., higher-level gait disorders, including normal-pressure
hydrocephalus with transependimal exudate). These syndromic designations are
preferable over VaP until pathology or validated biomarkers confirm the
underlying nature and relevance of the leukoaraiosis. © 2015 International
Parkinson and Movement Disorder Society.
|Cerebrovascular Disorders/*classification/pathology/physiopathology
[MESH]|Humans
[MESH]|Parkinsonian Disorders/*classification/pathology/physiopathology
[MESH]
 
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