Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis
Identifieur interne : 003D67 ( Main/Exploration ); précédent : 003D66; suivant : 003D68Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis
Auteurs : Jan C. M. Zijlmans [Royaume-Uni, Pays-Bas] ; Susan E. Daniel [Royaume-Uni] ; Andrew J. Hughes [Royaume-Uni, Australie] ; Tamas Révész [Royaume-Uni] ; Andrew Lees (neurologue) [Royaume-Uni]Source :
- Movement Disorders [ 0885-3185 ] ; 2004-06.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Brain (blood supply), Brain (pathology), Cerebrovascular Disorders (diagnosis), Cerebrovascular Disorders (epidemiology), Cerebrovascular Disorders (pathology), Clinical investigation, Diagnosis, Diagnosis, Differential, Eye Movements (physiology), Female, Gliosis (pathology), Humans, Hypertension (epidemiology), Male, Nervous system diseases, Parkinsonian Disorders (diagnosis), Parkinsonian Disorders (epidemiology), Parkinsonian Disorders (pathology), Parkinsonism, Severity of Illness Index, Stroke (epidemiology), Stroke (pathology), Substantia Nigra (pathology), Tremor (epidemiology), clinicopathological, diagnosis, subcortical lesions, vascular parkinsonism.
- MESH :
- blood supply : Brain.
- diagnosis : Cerebrovascular Disorders, Parkinsonian Disorders.
- epidemiology : Cerebrovascular Disorders, Hypertension, Parkinsonian Disorders, Stroke, Tremor.
- pathology : Brain, Cerebrovascular Disorders, Gliosis, Parkinsonian Disorders, Stroke, Substantia Nigra.
- physiology : Eye Movements.
- Aged, Aged, 80 and over, Diagnosis, Differential, Female, Humans, Male, Severity of Illness Index.
Abstract
Vascular parkinsonism (VP) is difficult to diagnose with any degree of clinical certainty. We investigated the importance of macroscopic cerebral infarcts and pathological findings associated with microscopic “small vessel disease” (SVD) in the aetiology of VP. The severity of microscopic SVD pathology (perivascular pallor, gliosis, hyaline thickening, and enlargement of perivascular spaces) and the presence of macroscopically visible infarcts were assessed in 17 patients with parkinsonism and no pathological evidence of either Parkinson's disease or any histopathological condition known to be associated with a parkinsonian syndrome, and compared with age‐matched controls. Microscopic SVD pathology was significantly more severe in the parkinsonian brains. Most patients presented with bilateral bradykinesia and rigidity together with a gait disorder characterised predominantly by a shuffling gait. Four patients presented acutely with hemiparesis and then progressed to develop a parkinsonian syndrome. They could be distinguished from the remaining VP patients by the presence at autopsy of macroscopically visible lacunar infarcts in regions where contralateral thalamocortical drive might be reduced. The clinical features at presentation varied according to the speed of onset and the underlying vascular pathological state. New clinical criteria for a diagnosis of VP are proposed based on the clinicopathological findings of this study. © 2004 Movement Disorder Society
Url:
DOI: 10.1002/mds.20083
Affiliations:
- Australie, Pays-Bas, Royaume-Uni
- Angleterre, Grand Londres, Hollande-Septentrionale
- Amsterdam, Londres
- National Hospital for Neurology and Neurosurgery
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M." last="Zijlmans">Jan C. M. Zijlmans</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Queen Square Brain Bank for Neurological Disorders, Institute of Neurology Queen Square, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Neurology, VU University Medical Center, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Daniel, Susan E" sort="Daniel, Susan E" uniqKey="Daniel S" first="Susan E." last="Daniel">Susan E. 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Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2004-06">2004-06</date><biblScope unit="vol">19</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="630">630</biblScope><biblScope unit="page" to="640">640</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">DAA429D87E677583E20E09C17496601689A62F44</idno><idno type="DOI">10.1002/mds.20083</idno><idno type="ArticleID">MDS20083</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Brain (blood supply)</term><term>Brain (pathology)</term><term>Cerebrovascular Disorders (diagnosis)</term><term>Cerebrovascular Disorders (epidemiology)</term><term>Cerebrovascular Disorders (pathology)</term><term>Clinical investigation</term><term>Diagnosis</term><term>Diagnosis, Differential</term><term>Eye Movements (physiology)</term><term>Female</term><term>Gliosis (pathology)</term><term>Humans</term><term>Hypertension (epidemiology)</term><term>Male</term><term>Nervous system diseases</term><term>Parkinsonian Disorders (diagnosis)</term><term>Parkinsonian Disorders (epidemiology)</term><term>Parkinsonian Disorders (pathology)</term><term>Parkinsonism</term><term>Severity of Illness Index</term><term>Stroke (epidemiology)</term><term>Stroke (pathology)</term><term>Substantia Nigra (pathology)</term><term>Tremor (epidemiology)</term><term>clinicopathological</term><term>diagnosis</term><term>subcortical lesions</term><term>vascular parkinsonism</term></keywords><keywords scheme="MESH" qualifier="blood supply" xml:lang="en"><term>Brain</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Cerebrovascular Disorders</term><term>Parkinsonian Disorders</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Cerebrovascular Disorders</term><term>Hypertension</term><term>Parkinsonian Disorders</term><term>Stroke</term><term>Tremor</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Brain</term><term>Cerebrovascular Disorders</term><term>Gliosis</term><term>Parkinsonian Disorders</term><term>Stroke</term><term>Substantia Nigra</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Eye Movements</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Diagnosis, Differential</term><term>Female</term><term>Humans</term><term>Male</term><term>Severity of Illness Index</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Diagnostic</term><term>Exploration clinique</term><term>Parkinsonisme</term><term>Système nerveux pathologie</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Vascular parkinsonism (VP) is difficult to diagnose with any degree of clinical certainty. We investigated the importance of macroscopic cerebral infarcts and pathological findings associated with microscopic “small vessel disease” (SVD) in the aetiology of VP. The severity of microscopic SVD pathology (perivascular pallor, gliosis, hyaline thickening, and enlargement of perivascular spaces) and the presence of macroscopically visible infarcts were assessed in 17 patients with parkinsonism and no pathological evidence of either Parkinson's disease or any histopathological condition known to be associated with a parkinsonian syndrome, and compared with age‐matched controls. Microscopic SVD pathology was significantly more severe in the parkinsonian brains. Most patients presented with bilateral bradykinesia and rigidity together with a gait disorder characterised predominantly by a shuffling gait. Four patients presented acutely with hemiparesis and then progressed to develop a parkinsonian syndrome. They could be distinguished from the remaining VP patients by the presence at autopsy of macroscopically visible lacunar infarcts in regions where contralateral thalamocortical drive might be reduced. The clinical features at presentation varied according to the speed of onset and the underlying vascular pathological state. New clinical criteria for a diagnosis of VP are proposed based on the clinicopathological findings of this study. © 2004 Movement Disorder Society</div></front></TEI><affiliations><list><country><li>Australie</li><li>Pays-Bas</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Hollande-Septentrionale</li></region><settlement><li>Amsterdam</li><li>Londres</li></settlement><orgName><li>National Hospital for Neurology and Neurosurgery</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Zijlmans, Jan C M" sort="Zijlmans, Jan C M" uniqKey="Zijlmans J" first="Jan C. M." last="Zijlmans">Jan C. M. Zijlmans</name></region><name sortKey="Daniel, Susan E" sort="Daniel, Susan E" uniqKey="Daniel S" first="Susan E." last="Daniel">Susan E. Daniel</name><name sortKey="Hughes, Andrew J" sort="Hughes, Andrew J" uniqKey="Hughes A" first="Andrew J." last="Hughes">Andrew J. Hughes</name><name sortKey="Lees, Andrew J" sort="Lees, Andrew J" uniqKey="Lees A" first="Andrew J." last="Lees">Andrew Lees (neurologue)</name><name sortKey="Revesz, Tamas" sort="Revesz, Tamas" uniqKey="Revesz T" first="Tamas" last="Révész">Tamas Révész</name></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Zijlmans, Jan C M" sort="Zijlmans, Jan C M" uniqKey="Zijlmans J" first="Jan C. M." last="Zijlmans">Jan C. M. Zijlmans</name></region></country><country name="Australie"><noRegion><name sortKey="Hughes, Andrew J" sort="Hughes, Andrew J" uniqKey="Hughes A" first="Andrew J." last="Hughes">Andrew J. Hughes</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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