Vascular Parkinsonism (VP)

Vascular Parkinsonism (VP)

Etiology

(1) Causes

VP often occurs abruptly after an acute stroke or systemic hypoxemia, or develops gradually following multiple strokes. Symptoms typically progress in a stepwise manner and are initially asymmetrical.

(2) Pathogenesis

  • Key Findings: Autopsy studies reveal lacunar infarcts in the basal ganglia (e.g., caudate nucleus, globus pallidus, thalamus) and midbrain, while the substantia nigra remains intact.
  • Frontal White Matter Damage: Recent research highlights extensive frontal white matter lesions as critical contributors to VP, even with milder basal ganglia involvement.

Symptoms

Core Clinical Features:

  1. Gait Disturbance: Magnetic foot response (severe initiation difficulty), short shuffling steps.
  2. Motor Symptoms: Rigidity (asymmetric, lead-pipe type), bradykinesia, masked facies.
  3. Non-Motor Symptoms: Dementia (common), pyramidal signs (e.g., hyperreflexia), pseudobulbar palsy.
  4. Course: Acute or insidious onset; partial spontaneous remission possible.

Diagnosis

Key Criteria:

  1. Medical History: Hypertension, diabetes, or recurrent strokes.
  2. Imaging (MRI): Subcortical white matter/gray matter lesions (e.g., basal ganglia lacunar infarcts, leukoaraiosis). Lesion volume >0.6% of total brain tissue.
  3. Exclusion: Poor response to levodopa; absence of Lewy bodies.

VP vs. Parkinson’s Disease (PD):

FeatureVPPD
TremorRare (17%)Common (73%, resting tremor)
RigidityAsymmetric, lead-pipeCogwheel
Pyramidal SignsPresent (>50%)Absent
MRI FindingsBasal ganglia/white matter lesionsNormal (except substantia nigra atrophy)

Treatment & Management

  1. Vascular Risk Control:
    • Antihypertensives, antidiabetics, antiplatelets (e.g., aspirin).
  2. Symptomatic Therapy:
    • Limited levodopa response (20–30% show partial improvement).
    • Physical therapy for gait training.
  3. Prognosis: Irreversible progression; focus on preventing recurrent strokes.

Prevention & Care

  • Diet: Low-salt, low-fat; manage blood sugar/pressure.
  • Monitoring: Regular MRI/neuroassessments.
  • Complications: Fall prevention, dysphagia management.

External Links for Key Terms:

For further reading, explore latest VP treatment advances.

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