Rektor Ivan, Rektorová Irena, Kubová Dagmar
First Department of Neurology, Medical Faculty of Masaryk University, St. Anne's Teaching Hospital, Pekarska 53, 65691 Brno, Czech Republic.
J Neurol Sci. 2006 Oct 25;248(1-2):185-91. doi: 10.1016/j.jns.2006.05.026.
Vascular parkinsonism (VP) is a heterogeneous clinical entity. The idea of a relationship between cerebral vascular disease and parkinsonism may be traced back to the 1920s, when the diagnostic unit called "arteriosclerotic parkinsonism", a predecessor of VP, was established. This review is concerned with historical and contemporary views regarding the possible vascular genesis of parkinsonism. Confusion persists as a result of vaguely defined diagnostic criteria. The following types of simultaneous occurrence of parkinsonism and cerebral vascular disease (CVD) may be recognised: 1. gait disorders of the lower body parkinsonism type are caused mostly by white matter lesions in the frontal lobes; such disorders may require a diagnosis of vascular origin. We suggest replacing the term "lower body parkinsonism" with a more appropriate term not including the word "parkinsonism": an alternative term could be "cerebrovascular gait disorder"; 2. if the signs and symptoms are typical for idiopathic Parkinson's disease (IPD), the coincidence of IPD and CVD should be considered; 3. if the symptoms of parkinsonism are neither typical for IPD nor for VP, and there are clinical or MR signs of CVD, VP should be regarded as possible when alternative causes are excluded; 4. if the symptoms of parkinsonism and clinical and MR signs are typical for VP, VP should be regarded as probable; 5. if a stroke affecting the contralateral basal ganglia is followed by the occurrence of hemiparkinsonism, the diagnosis of VP is unambiguous. Vascular parkinsonism (VP) is probably one of the most frequently erroneous neurological diagnoses. The reason for this misdiagnosis is that both cerebral vascular disease (CVD) and parkinsonism usually occur at the same age. Due to the high incidence of CVD, it is possible for CVD and idiopathic Parkinson's disease (IPD) to coincide in some cases. Another reason for the misdiagnosis is that the concept of VP lacks clarity. This review aims to contribute to an improved understanding of VP in clinical practice. In this context, the term "CVD" is understood in the broad sense of a brain impairment caused by cerebral vessel pathology. It covers various concepts, as some authors use the term CVD to mean a manifestation of vascular lesions in pathologico-anatomical material or in the imaging techniques; others mean the history and clinical manifestation of cerebral ischaemia, or, more rarely, haemorrhage. The term CVD may cover large vessel disease as well as small vessel disease. This means that territorial and lacunar infarcts and white matter lesions (WML) are all considered as CVD.
血管性帕金森综合征（VP）是一种异质性临床实体。脑血管疾病与帕金森综合征之间存在关联的观点可追溯到20世纪20年代，当时名为“动脉硬化性帕金森综合征”（VP的前身）的诊断单元得以确立。本综述关注关于帕金森综合征可能的血管起源的历史和当代观点。由于诊断标准定义模糊，混淆依然存在。帕金森综合征与脑血管疾病（CVD）同时出现的以下几种类型可被识别：1. 下半身帕金森综合征类型的步态障碍主要由额叶白质病变引起；此类障碍可能需要诊断为血管源性。我们建议用一个更合适的术语替换“下半身帕金森综合征”，该术语不包含“帕金森综合征”一词：一个替代术语可以是“脑血管性步态障碍”；2. 如果体征和症状符合特发性帕金森病（IPD）的典型表现，则应考虑IPD与CVD的巧合；3. 如果帕金森综合征的症状既不符合IPD的典型表现也不符合VP的典型表现，且存在CVD的临床或磁共振成像（MR）体征，在排除其他病因后应考虑VP；4. 如果帕金森综合征的症状以及临床和MR体征符合VP的典型表现，则应考虑VP很可能成立；5. 如果影响对侧基底节的中风后出现偏侧帕金森综合征，VP的诊断则明确无疑。血管性帕金森综合征（VP）可能是最常被误诊的神经系统疾病之一。这种误诊的原因在于脑血管疾病（CVD）和帕金森综合征通常在相同年龄出现。由于CVD的高发病率，在某些情况下CVD与特发性帕金森病（IPD）可能会同时存在。误诊的另一个原因是VP的概念缺乏清晰度。本综述旨在有助于在临床实践中更好地理解VP。在此背景下，“CVD”一词在广义上被理解为由脑血管病变引起的脑损伤。它涵盖各种概念，因为一些作者使用“CVD”一词表示病理解剖材料或成像技术中血管病变的表现；另一些人指的是脑缺血的病史和临床表现，或者更罕见的出血情况。“CVD”一词可能涵盖大血管疾病以及小血管疾病。这意味着区域性和腔隙性梗死以及白质病变（WML）都被视为CVD。
