VASCULAR (MULTI-INFARCT)
PARKINSONISM
Philip A. Hanna, M.D.
Parkinson's Disease and Movement Disorders Center
New Jersey Neuroscience Institute
Edison, New Jersey
Vascular parkinsonism is a neurological disorder in which the symptoms
of parkinsonism (tremor at rest, rigidity, slowness of movement, and
difficulty walking) are a result of small strokes, rather than by
gradual loss of nerve cells. When one or more strokes occur in the
basal ganglia (a part of the brain involved in the control of
movements) on one side of the brain, the patient may develop
parkinsonism on the opposite side of the body.
Parkinsonism can present suddenly in these patients, in conjunction
with a stroke-like event. Most patients with this form of parkinsonism
are not aware of the individual strokes. Symptoms may progress
gradually and resemble the progression of Parkinson's disease. In
addition to stroke risk factors such as diabetes, high blood pressure,
smoking and heart disease, the diagnosis is supported by primary
involvement of the legs, and abnormal brain scans.
The treatment of vascular parkinsonism is to seek to prevent further
strokes by reducing risk factors such as smoking, high blood pressure,
diabetes, high cholesterol, obesity, and a sedentary lifestyle. Taking
an aspirin a day (if recommended by your doctor) is a good way to
modestly thin the blood and decrease the risk of stroke and heart
attack. A trial of levodopa and other anti-parkinsonian medications is
generally worth trying although typically does not provide marked
benefit. Physical therapy, particulary gait training may be helpful.
Removing spinal fluid (via a lumbar puncture) may be helpful in a
select group of patients with specific patterns of changes on MRI
imaging.
Winikates J, Jankovic J. Clinical correlates of vascular parkinsonism.
Arch Neurol 1999;56:98-102.
Hanna PA, Cardoso F, Jankovic J. Basal Ganglia and Movement Disorders.
In: Rolak LA, ed. Neurology Secrets, 2nd ed. New York: Hanley and
Belfus, 1998:137-169.
Fitzgerald, PM, Jankovic J: Lower body parkinsonism: Evidence for
vascular etiology. Mov Disord 1989;4:249-260.
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