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Vascular Parkinsonism: deconstructing a syndrome.

Joaquin A Vizcarra1, Anthony E Lang2, Kapil D Sethi3

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Vascular parkinsonism (VaP) diagnosis is complex, as abnormal white matter signals lack specificity. Many VaP cases may be misdiagnosed neurodegenerative conditions or other disorders.

Keywords:
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Area of Science:

  • Neurology
  • Neuroimaging
  • Movement Disorders

Background:

  • Vascular parkinsonism (VaP) is diagnosed based on progressive ambulatory impairment and white matter (WM) abnormalities on neuroimaging.
  • Current literature suggests limitations in the diagnostic specificity of imaging findings for VaP.

Purpose of the Study:

  • To critically appraise the literature regarding the diagnostic criteria and specificity of neuroimaging in vascular parkinsonism.
  • To differentiate true vascular parkinsonism from conditions with overlapping clinical and imaging features.

Main Methods:

  • Literature review and critical appraisal of existing clinicopathologic and neuroimaging studies related to vascular parkinsonism.
  • Analysis of the correlation between brain MRI hyperintensities, microangiopathic disease, and parkinsonism.

Main Results:

  • No specific structural imaging pattern is definitively associated with VaP.
  • Poor correlation exists between MRI white matter hyperintensities and the presence of microangiopathic brain disease and parkinsonism.
  • Definite vascular parkinsonism results from specific stroke locations (SN/nigrostriatal pathway) sparing certain brain regions.
  • Many reported VaP cases may represent pseudovascular parkinsonism (e.g., Parkinson's disease, PSP), vascular pseudoparkinsonism (e.g., akinetic mutism), or pseudovascular pseudoparkinsonism (e.g., NPH).

Conclusions:

  • The term vascular parkinsonism (VaP) should be used cautiously until pathology or validated biomarkers confirm the diagnosis.
  • Alternative syndromic designations are recommended for cases with nonspecific neuroimaging findings to avoid misdiagnosis.
  • Distinguishing VaP from other parkinsonian disorders and gait disturbances based solely on neuroimaging is challenging.