Department of Psychiatry, Beijing Geriatric Hospital, 100095, Beijing, P.R. China.
Chinese People's Liberation Army General Hospital, Beijing, 100853, P.R. China.
BMC Neurol. 2021 Jan 11;21(1):15. doi: 10.1186/s12883-020-02038-y.
Vascular Parkinsonism(VaP) is defined as parkinsonism resulting from cerebral vascular disease(CVD), with presence of variable motor and non-motor signs that are corroborated by clinical, anatomic or imaging findings of cerebrovascular disease. Overlapping syndromes with mixed pathologies make VaP difficult to distinguish from primary neurodegenerative parkinsonism.To understand the clinical and pathological features of VaP,we report a case of autopsy confirmed vascular Parkinsonism that was clinical misdiagnosed as idiopathic Parkinson's disease.Clinical features include early mixed symptoms of dementia,behavioral disturbance and parkinsonism that were similar to Dementia with lewy Body(DLB) and Parkinson disease Dementia(PDD).
A 84-year-old man presented progressive parkinsonism with prominent postural instability, gait impairment, pseudobulbar, early cognitive impairment, irritability, hallucination, urinary symptoms and poor responsiveness to dopaminergic drugs. He was clinically diagnosed as Parkinson disease(PD). In the post-mortem study, we examined Aβ and phospho-tau as pathological biomarker for Alzheimer's disease(AD), α-synucleing in medulla, pons and midbrain for PD and DLB. Hematoxylin and eosin staining in cerebral cortex, cerebellum and brainstem examines vascular pathological changes and microvascular lesion.Neither Lewy bodies in the substantia nigra ,locus ceruleus and cerebrumnor accumulation of Aβ, neurofibrillary tangles were noted. Instead, there were many cerebral infarctions and widespread arteriosclerosis in the brain. The final brain autopsy supported a diagnosis of VaP not PD.
This case of pathologically confirmed VaP misdiagnosed as idiopathic PD suggested that we must be vigilant about the possibility of VaP for patients with parkinsonisms, cognitive impairments, early behavioral and psychological symptoms,imaging performances of cerebral small vessel disease and other vascular damages.
血管性帕金森病（VaP）定义为由于脑血管疾病（CVD）引起的帕金森病，存在可变的运动和非运动体征，这些体征通过临床、解剖或影像学发现的脑血管疾病得到证实。重叠的综合征伴混合病理学使 VaP 难以与原发性神经退行性帕金森病区分开来。为了了解 VaP 的临床和病理特征，我们报告了一例经尸检证实的血管性帕金森病病例，该病例临床误诊为特发性帕金森病。临床特征包括痴呆、行为障碍和帕金森病的早期混合症状，类似于路易体痴呆（DLB）和帕金森病痴呆（PDD）。
一名 84 岁男性出现进行性帕金森病，突出表现为姿势不稳、步态障碍、假性延髓、早期认知障碍、易激惹、幻觉、尿症状和对多巴胺能药物反应不佳。他被临床诊断为帕金森病（PD）。在尸检研究中，我们检查了 Aβ 和磷酸化 tau 作为阿尔茨海默病（AD）的病理生物标志物，延髓、脑桥和中脑的α-突触核蛋白作为 PD 和 DLB 的生物标志物。大脑皮质、小脑和脑干的苏木精和伊红染色检查血管病理变化和微血管病变。未发现黑质中的路易体、蓝斑和大脑的 Aβ 积聚，也未发现神经纤维缠结。相反，大脑中有许多脑梗死和广泛的动脉粥样硬化。最终的脑尸检支持 VaP 的诊断，而不是 PD。
本病例经病理证实的 VaP 误诊为特发性 PD，提示我们对于帕金森病、认知障碍、早期行为和心理症状、脑小血管病的影像学表现和其他血管损伤的患者，必须警惕 VaP 的可能性。
