Volume 19, Issue 6 p. 630-640
Research Article

Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis

Jan C.M. Zijlmans MD, PhD

Corresponding Author

Jan C.M. Zijlmans MD, PhD

Queen Square Brain Bank for Neurological Disorders, Institute of Neurology Queen Square, London, United Kingdom

Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands

Department of Neurology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The NetherlandsSearch for more papers by this author
Susan E. Daniel MD, FRCPath

Susan E. Daniel MD, FRCPath

Queen Square Brain Bank for Neurological Disorders, Institute of Neurology Queen Square, London, United Kingdom

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Andrew J. Hughes MD, FRACP

Andrew J. Hughes MD, FRACP

Queen Square Brain Bank for Neurological Disorders, Institute of Neurology Queen Square, London, United Kingdom

Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia

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Tamas Révész MD, FRCPath

Tamas Révész MD, FRCPath

Queen Square Brain Bank for Neurological Disorders, Institute of Neurology Queen Square, London, United Kingdom

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Andrew J. Lees MD, FRCP

Andrew J. Lees MD, FRCP

Queen Square Brain Bank for Neurological Disorders, Institute of Neurology Queen Square, London, United Kingdom

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First published: 16 March 2004
Citations: 271

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