Vascular parkinsonism (VP), originally known as arteriosclerotic parkinsonism, is a heterogeneous but clinically recognizable entity which is comprised of predominantly “lower body parkinsonism,” postural instability, and falls. In comparison with Parkinson’s disease (PD), patients with VP tend to be older, have a shorter duration of illness, may have a stepwise decline, present with symmetrical gait difficulties, are less responsive to levodopa, and are more prone to postural instability, falls, and dementia. Pyramidal signs, pseudobulbar palsy, and incontinence are commonly present. While no specific abnormal structural imaging pattern is suggestive of VP, brain CT and MRI often demonstrate evidence of vascular impairment with frequent involvement of more than one vascular territory and abnormalities in periventricular and subcortical white matter and basal ganglia.
KeywordsBasal Ganglion Stride Length Postural Instability Subcortical White Matter Pyramidal Sign
Vascular parkinsonism.mp4 (MP4 57,432KB)
Motor examination reveals relatively mild parkinsonism in upper extremities. Voice is hypophonic and monotonic. Signs of parkinsonism predominantly affect the lower extremities with short stride length, shuffling gait, and occasional freezing of gait. Freezing of gait could be overcome by stepping over obstacles. Pull testing is positive.