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Das vaskuläre Parkinson-Syndrom

Vascular parkinsonian syndrome

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Zusammenfassung

In der vorliegenden Übersicht soll deutlich gemacht werden, dass ein vaskuläres Parkinson-Syndrom (VPS) im engeren Sinne eine seltene und klinisch nicht immer von der idiopathischen Parkinson abgrenzbare Erkrankung ist. Im klinischen Sprachgebrauch wird der Terminus VPS allerdings auch für andere Störungsbilder verwendet, die nicht zuletzt aufgrund der unterschiedlichen therapeutischen Implikationen von einem VPS differenziert werden sollten. Die Differenzialdiagnose des VPS umfasst in erster Linie die subkortikale arteriosklerotische Enzephalopathie, bei der eine Parkinson-artige Gangstörung nicht mit weiteren Kardinalsymptomen eines Parkinson-Syndroms verbunden ist sowie die Koexistenz eines neurodegenerativen Parkinson-Syndroms mit einer subkortikalen vaskulären Enzephalopathie. Ein akutes oder subakutes VPS entsteht in der Regel kontralateral zu Hirninfarkten, die den externen Teil des Globus pallidus, den ventrolateralen Teil des Thalamus und (seltener) die Substantia nigra betreffen. Chronische VPS mit schleichendem Beginn entstehen auf dem Boden bilateraler lakunärer subkortikaler Infarkte mit Beeinträchtigung thalamokortikaler Projektionen. Progressionsneigung und Dopa-Responsivität kommen bei akuten und chronischen VPS vor und erschweren die Differenzialdiagnose zu einem degenerativen Parkinson-Syndrom.

Summary

The present review shows that vascular parkinsonian syndrome (VPS) fulfilling stringent diagnostic criteria for parkinsonism is a rare disease that cannot always be distinguished from neurodegenerative parkinsonism on clinical grounds. Thus VPS needs to be differentiated from other disturbances, which have distinct phenomenological and therapeutical features including isolated gait disturbances associated with subcortical arteriosclerotic encephalopathy and neurodegenerative parkinsonism complicated by comorbid vascular encephalopathy. Acute or subacute VPS is usually caused by contralateral infarctions involving the external globus pallidus, ventrolateral thalamus, and, less often, the substantia nigra. Chronic VPS with insidious onset is related to bilateral subcortical infarctions affecting thalamocortical projections. Differentiation from degenerative parkinsonism is difficult in cases of VPS that display a progressive course and response to levodopa.

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Ebersbach, G., Poewe, W. Das vaskuläre Parkinson-Syndrom. Nervenarzt 77, 139–147 (2006). https://doi.org/10.1007/s00115-005-1978-6

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  • DOI: https://doi.org/10.1007/s00115-005-1978-6

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