Parkinsonism in patients with cerebral infarcts

From 220 necropsies of patients with cerebral infarcts, 5 were selected, in which the clinical history revealed typical parkinsonian symptoms with a progressive course of the extrapyramidal disorder. No correlation could be found between the location and the size of the infarcts on the one hand and the signs of parkinsonism on the other hand. In the 5 cases presented, the substantia nigra showed patchy areas of neuronal degeneration without any Lewy bodies nor neurofibrillary changes, around a pronounced status cribrosus in areas irrigated by paramedian branches of the mesencephalic arteries. Similar neuropathologic findings were present, but to a minor degree, in 2 of 5 cases of pseudo-bulbar palsy. Some extrapyramidal features were also present. It is proposed that is some rare instances, status cribrosus may be responsible for nigral degeneration and for the occurrence of parkinsonism.