Udagedara Thilini B, Gooneratne Inuka Kishara
Kegalle District General Hospital, Kegalle, Sri Lanka.
National Hospital of Sri Lanka, Colombo, Sri Lanka.
BMC Neurol. 2018 Jun 30;18(1):92. doi: 10.1186/s12883-018-1093-5.
Vascular Parkinsonism (VP) is a heterogeneous group of conditions that manifest clinically in parkinsonian features, but are presumably of vascular cause. It is usually bilateral, non-tremulous, and frequently associated with pyramidal signs. Classically VP is described as lower body parkinsonism affecting predominantly the legs.
A 67 years old lady presented with a history of acute onset jaw tremor, with tremor predominantly in both upper limbs. Neurological examination revealed hypomimia of the face with cogwheel rigidity and bradykinesia bilaterally, predominantly in the upper limbs without pyramidal signs. She had a marked tremor of the jaw at rest. When she was asked to open her mouth the tremor was re-emergent. Non contrast CT scan of her brain revealed an infarction in the region of putamen on the left with no evidence of diffuse subcortical white matter ischemia or extension to the caudate nucleus. She was treated with levodopa and responded well to medication.
This case describes atypical clinical features which could be associated with VP including jaw tremor. This case also stresses the importance of initiating a trial of levodopa as certain patients may respond well to medication.
血管性帕金森综合征（VP）是一组临床表现为帕金森样特征但推测由血管原因引起的异质性病症。它通常为双侧性，无震颤，且常伴有锥体束征。经典的VP被描述为主要影响下肢的下体帕金森综合征。
一位67岁女性，有急性发作的下颌震颤病史，震颤主要累及双上肢。神经系统检查发现面部表情减少，双侧齿轮样强直和运动迟缓，主要累及上肢，无锥体束征。她在静息时有明显的下颌震颤。当要求她张口时，震颤再次出现。脑部非增强CT扫描显示左侧壳核区域梗死，无弥漫性皮质下白质缺血或尾状核受累的证据。她接受了左旋多巴治疗，对药物反应良好。
本病例描述了可能与VP相关的非典型临床特征，包括下颌震颤。该病例还强调了启动左旋多巴试验的重要性，因为某些患者可能对药物反应良好。
