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Vascular parkinsonism: an update.

Kurt A Jellinger1

  • 1Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150, Vienna, Austria. kurt.jellinger@univie.ac.at.

Journal of Neural Transmission (Vienna, Austria : 1996)
|June 5, 2025
PubMed
Summary
This summary is machine-generated.

Vascular parkinsonism (VP), caused by cerebrovascular disease, presents unique motor and non-motor symptoms distinct from Parkinson disease (PD). Differentiating VP from PD and other parkinsonian syndromes requires advanced imaging and biomarkers.

Keywords:
Cerebrovascular diseaseNeuroimagingTreatment optionsVascular parkinsonismWhite matter lesions

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Area of Science:

  • Neurology
  • Neuroscience
  • Vascular Neurology

Background:

  • Vascular parkinsonism (VP) is a rare disorder (3-6% of parkinsonian syndromes) arising from cerebrovascular disease, presenting distinct clinical features from idiopathic Parkinson disease (PD).
  • VP exhibits heterogeneous clinical manifestations, including bilateral rigidity (lower body predominant), bradykinesia, postural instability, gait disturbances, falls, corticospinal signs, and cognitive impairment, with tremor being uncommon.
  • VP can overlap with other parkinsonian syndromes, necessitating precise diagnostic approaches.

Purpose of the Study:

  • To delineate the distinct clinical, neuroimaging, and neuropathological characteristics of vascular parkinsonism (VP).
  • To review current and emerging diagnostic methods for differentiating VP from Parkinson disease (PD) and other parkinsonian disorders.
  • To discuss the subtypes, pathogenesis, and therapeutic challenges associated with VP.

Main Methods:

  • Review of clinical features, neuroimaging findings (MRI, dopamine transporter imaging), and neuropathological data in VP.
  • Classification of VP into three subtypes: acute/subacute poststroke, insidious onset with white matter lesions/lacunar infarcts, and mixed VP/PD.
  • Analysis of diagnostic utility of advanced imaging and potential molecular biomarkers.

Main Results:

  • VP subtypes show varied presentations: acute VP may respond to dopaminergic drugs, while insidious VP often presents with prominent postural instability and poor levodopa response.
  • Neuroimaging typically reveals brain atrophy, deep white matter lesions, and lacunar infarcts, with rare direct nigrostriatal damage.
  • Neuropathology shows subcortical ischemic lesions due to small vessel disease, typically lacking Lewy pathology.

Conclusions:

  • Vascular parkinsonism (VP) is characterized by specific vascular pathologies and clinical profiles that distinguish it from Parkinson disease (PD).
  • Advanced MRI and dopamine transporter imaging aid in differentiating VP from other parkinsonian syndromes.
  • Further research into VP pathogenesis and novel therapeutic strategies is essential, given the modest response to current treatments.