La maladie de Parkinson au Canada (serveur d'exploration)

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Vascular parkinsonism: Deconstructing a syndrome

Identifieur interne : 000477 ( Main/Exploration ); précédent : 000476; suivant : 000478

Vascular parkinsonism: Deconstructing a syndrome

Auteurs : Joaquin A. Vizcarra [Pérou] ; Anthony E. Lang [Canada] ; Kapil D. Sethi [États-Unis] ; Alberto J. Espay [États-Unis]

Source :

RBID : PMC:4478160

English descriptors

Abstract

Progressive ambulatory impairment and abnormal white matter signal on neuroimaging come together under the diagnostic umbrella of vascular parkinsonism. A critical appraisal of the literature, however, suggests that (1) no abnormal structural imaging pattern is specific to vascular parkinsonism; (2) there is poor correlation between brain magnetic resonance imaging 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 substantia nigra and/or nigrostriatal pathway but sparing the striatum itself, the cortex, and the intervening white matter; and (4) many cases reported as vascular parkinsonism may represent pseudovascular parkinsonism (e.g., Parkinson disease or another neurodegenerative parkinsonism such as progressive supranuclear palsy with non-specific neuroimaging signal abnormalities), vascular pseudoparkinsonism (e.g., akinetic mutism due to 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 vascular parkinsonism until pathology or validated biomarkers confirm the underlying nature and relevance of the leukoaraiosis.


Url:
DOI: 10.1002/mds.26263
PubMed: 25997420
PubMed Central: 4478160


Affiliations:


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<p id="P1">Progressive ambulatory impairment and abnormal white matter signal on neuroimaging come together under the diagnostic umbrella of vascular parkinsonism. A critical appraisal of the literature, however, suggests that (1) no abnormal structural imaging pattern is specific to vascular parkinsonism; (2) there is poor correlation between brain magnetic resonance imaging hyperintensities
<italic>and</italic>
microangiopathic brain disease
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parkinsonism from available clinicopathologic data; (3)
<italic>pure</italic>
parkinsonism from vascular injury (“definite” vascular parkinsonism) consistently results from ischemic or hemorrhagic strokes involving the substantia nigra and/or nigrostriatal pathway but sparing the striatum itself, the cortex, and the intervening white matter; and (4) many cases reported as vascular parkinsonism may represent
<italic>pseudovascular</italic>
parkinsonism (e.g., Parkinson disease or another neurodegenerative parkinsonism such as progressive supranuclear palsy with non-specific neuroimaging signal abnormalities), vascular
<italic>pseudoparkinsonism</italic>
(e.g., akinetic mutism due to bilateral mesial frontal strokes or apathetic depression from bilateral striatal lacunar strokes), or
<italic>pseudovascular pseudoparkinsonism</italic>
(e.g., higher-level gait disorders, including normal pressure hydrocephalus with transependimal exudate). These syndromic designations are preferable over
<italic>vascular parkinsonism</italic>
until pathology or validated biomarkers confirm the underlying nature and relevance of the leukoaraiosis.</p>
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