Yamanouchi H, Nagura H
Department of Neurology, Tokyo Metropolitan Geriatric Hospital.
Rinsho Shinkeigaku. 1995 Dec;35(12):1457-8.
We investigated the existence, clinical symptoms, and brain pathology of cerebrovascular parkinsonism. In this study, clinicopathological criteria of cerebrovascular parkinsonism was defined as follows: 1) at least 2 or more symptoms from the following 4 symptoms: tremor, rigidity, akinesia or bradykinesia, and short stepped gait or freezing, 2) no depigmentation, no Lewy body at the substantia nigra, no other degenerative disease, and 3) existence of cerebrovascular lesions. Among consecutive 4,000 autopsy series in the elderly, clinicopathologically confirmed cerebrovascular parkinsonism was found in 24 patients with mean age of 80 years. Cerebrovascular parkinsonism was characterized by the short-stepped gait as initial symptoms, absence of the resting tremor, lead-pipe rigidity, the symmetry of findings, and negative response to levodopa. Pseudobulbar palsy was observed in 54%, pyramidal findings in 63% of the cases. Most cases had multiple vascular lesions of the basal ganglia, but the distribution of lesions was not different from that in the cases of progressive subcortical vascular encephalopathy of Binswanger type without parkinsonism. Diffuse pallor and the loss of oligodendrocytes in the frontal white matter observed in the cerebrovascular parkinsonism suggested that the symptoms of parkinsonism resulted from the white matter damages in the frontal lobe.
我们研究了脑血管性帕金森综合征的存在情况、临床症状及脑部病理。在本研究中，脑血管性帕金森综合征的临床病理标准定义如下：1）具备以下4种症状中的至少2种：震颤、强直、运动不能或运动迟缓、短步距步态或冻结步态；2）无色素脱失，黑质无路易小体，无其他退行性疾病；3）存在脑血管病变。在连续4000例老年尸检病例中，经临床病理证实的脑血管性帕金森综合征在24例患者中被发现，平均年龄为80岁。脑血管性帕金森综合征的特点是以短步距步态为初始症状，无静止性震颤，铅管样强直，检查结果对称，对左旋多巴反应阴性。54%的病例观察到假性球麻痹，63%的病例有锥体束征。大多数病例有基底节区多发血管病变，但病变分布与无帕金森综合征的宾斯旺格型进行性皮质下血管性脑病病例并无差异。脑血管性帕金森综合征中观察到的额叶白质弥漫性苍白和少突胶质细胞丢失提示帕金森综合征症状是由额叶白质损害所致。
