Vascular Parkinsonism

Deconstructing a Syndrome

Joaquin A. Vizcarra, Anthony E. Lang, Kapil Dev Sethi, Alberto J. Espay

Research output: Contribution to journalReview article

40 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)886-894
Number of pages9
JournalMovement Disorders
Volume30
Issue number7
DOIs
StatePublished - Jun 1 2015

Fingerprint

Parkinsonian Disorders
Blood Vessels
Neuroimaging
Akinetic Mutism
Leukoaraiosis
Stroke
Normal Pressure Hydrocephalus
Lacunar Stroke
Corpus Striatum
Vascular System Injuries
Brain Diseases
Exudates and Transudates
Gait
Parkinson Disease
Biomarkers
Pathology
Brain

Keywords

  • Higher-level gait disorder
  • Normal-pressure hydrocephalus
  • Vascular parkinsonism
  • White matter ischemic disease

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Vizcarra, J. A., Lang, A. E., Sethi, K. D., & Espay, A. J. (2015). Vascular Parkinsonism: Deconstructing a Syndrome. Movement Disorders, 30(7), 886-894. https://doi.org/10.1002/mds.26263

Vascular Parkinsonism : Deconstructing a Syndrome. / Vizcarra, Joaquin A.; Lang, Anthony E.; Sethi, Kapil Dev; Espay, Alberto J.

In: Movement Disorders, Vol. 30, No. 7, 01.06.2015, p. 886-894.

Research output: Contribution to journalReview article

Vizcarra, JA, Lang, AE, Sethi, KD & Espay, AJ 2015, 'Vascular Parkinsonism: Deconstructing a Syndrome', Movement Disorders, vol. 30, no. 7, pp. 886-894. https://doi.org/10.1002/mds.26263
Vizcarra JA, Lang AE, Sethi KD, Espay AJ. Vascular Parkinsonism: Deconstructing a Syndrome. Movement Disorders. 2015 Jun 1;30(7):886-894. https://doi.org/10.1002/mds.26263
Vizcarra, Joaquin A. ; Lang, Anthony E. ; Sethi, Kapil Dev ; Espay, Alberto J. / Vascular Parkinsonism : Deconstructing a Syndrome. In: Movement Disorders. 2015 ; Vol. 30, No. 7. pp. 886-894.
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