Vascular parkinsonism

Vascular parkinsonism is a highly controversial concept since its first description by Critchley in 1929. There is no doubt that cerebrovascular disease can cause elements of parkinsonism. However, the extent of the spectrum of vascular parkinsonism remains quite imprecise. Here we review recent epidemiological, clinical, electrophysiological, morphological and functional brain imaging and pathological studies on 'vascular parkinsonism'.

Epidemiological studies have demonstrated that vascular parkinsonism represents 3-5% of all cases of parkinsonism. The more specific clinical features are a history of stroke, lower body parkinsonism and poor levodopa response. Vascular risk factors are dominated by arterial hypertension, whereas others have been less evaluated. Vascular lesions within or outside the basal ganglia, unique and multiple, lacunae or territorial infarcts can be demonstrated by magnetic resonance imaging. Functional imaging of the dopaminergic pathway helps to differentiate vascular parkinsonism from idiopathic Parkinson's disease. However, none of these clinical or imaging criteria taken alone are specific for the diagnosis. A combination of convergent clinical and imaging clues are therefore necessary to improve the accuracy of the diagnosis, which is only certain when the pathology excludes underlying idiopathic Parkinson's disease.

At present it remains unexplained why some patients develop vascular parkinsonism and others do not with the same apparent vascular lesion load. This will need further research along with the need to develop criteria to improve the accuracy of diagnosis of vascular parkinsonism. Vascular parkinsonism is also a research field on the relationships between vascular brain lesions and neurodegenerative disorders.