VASCULAR PARKINSONISM: CLINICAL MANIFESTATIONS, DIAGNOSTIC CRITERIA (CLINICAL CASE)

Krivchun A. M., Pinchuk V. A., Silenko G. Ya.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Vascular parkinsonism is a variant of secondary (symptomatic, atypical) parkinsonism, which occurs as a result of ischemic or hemorrhagic lesions of the basal ganglia, midbrain and (or) their connections with the frontal lobes. The development of vascular parkinsonism is associated with the defeat of “strategic” areas of the brain: the shell, the pale layer/globus pallidus, the white matter of the frontal lobes, the thalamus, the midbrain as a result of cerebrovascular diseases. The main cause of vascular parkinsonism is hypertension (microangiopathy), atherosclerosis of cerebral arteries of large and medium caliber (macroangiopathy), hemorrhage in the midbrain and shell, cardioembolism of cerebral vessels. For the clinician, the most important point is the differential diagnosis of vascular parkinsonism with manifestations of parkinsonism from other etiologies, in particular Parkinson’s disease. Vascular parkinsonism differs more rapid progression and unfavorable outcome, compared with Parkinson’s disease. The clinical picture of vascular parkinsonism is characterized by a predominance of rigidity and bradykinesia. Often, patients are affected for a long time only by the lower extremities, the so-called “parkinsonism of the lower half of the body.” Characteristic gait disorders are shuffling gait, stiffness when walking, as well as coarse postural instability. At the same time, tremor of rest, as well as other non-motor manifestations typical for Parkinson’s disease are almost absent. Also are common pyramidal symptoms, pseudobulbar palsy, urinary incontinence, and cognitive impairment. The strategy of VP treatment is divided into basic and symptomatic therapy. Basic therapy is aimed to prevent the progression of cerebrovascular pathology and includes a correction of cardiovascular risk factors. Symptomatic treatment involves the using of anti- parkinsonian drugs, individually selected titrated doses and correction of concomitant neurological syndromes. The main thing in the diagnosis of vascular parkinsonism is to confirm the relationship in time between the development of vascular parkinsonism and cerebrovascular disease. And the urgency of the problem lies in the complexity of diagnosis, rapid progression and unfavorable prognosis of vascular parkinsonism. The aim of our research was to study the features of clinical manifestations, modern criteria of diagnosis and treatment approaches to vascular parkinsonism based on the analysis of our own clinical observations. A clinical case of a patient with vascular parkinsonism is presented. There are identified clinical syndromes of «parkinsonism of lower part of the body», cognitive disorders, the presence of focal neurological symptoms. Pathological changes on MRI of brain are described like specific diffuse lesions of white matter and subcortical infarcts, there is a causal link between parkinsonism and cerebrovascular disease. Differential diagnosis with Parkinson’s disease and correction of therapy. Holding the differential diagnosis of vascular parkinsonism with Parkinson’s syndromes of other etiology is crucial importance for the prognosis of the disease and determine the tactics of the patient.

vascular parkinsonism, clinical features, diagnostic criteria.

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«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 116-120 pages, index UDK 616.858.-008.6.-03:616-005-02

10.29254/2077-4214-2020-2-156-116-120