Progress of Vascular Parkinsonism

doi:10.3969/j.issn.1673-5765.2022.04.004

Abstract

Abstract: Vascular parkinsonism (VaP) is a common secondary Parkinson's syndrome, which is caused by hypoxia of basal ganglia neuron network, metabolic abnormal, and destroy of neural microenvironment caused by cerebral small vessels injury. The clinical manifestations of VaP are related to vascular injury, and the risk factors, etiology and clinical manifestations of which are significantly different from that of Parkinson's disease (PD). However, as they have some common symptoms, VaP and PD may be misdiagnosed clinically. The development of auxiliary examination technology is helpful for the diagnosis of VaP. For example, the volume of white matter hyperintensity (WMH) in caudate nucleus, basal ganglia and subcortical areas measured by brain MRI, and substantia nigra imaging on SWI can help distinguish VaP from PD. In addition, some new technologies such as molecular imaging and neural network gait pattern assessment based on gait time series can also help distinguish VaP from PD.

Key words: Vascular parkinsonism; White matter hyperintensity; Cerebral small vessel disease;Influencing factor; Magnetic resonance imaging

摘要： 血管性帕金森综合征（vascular parkinsonism，VaP）是临床上常见的继发性帕金森综合征的一种，由脑小血管损伤引起基底节神经元网络缺氧、代谢异常以及神经微环境的完整性破坏等导致。 VaP的临床表现与血管损伤有关，其危险因素、病因、临床表现与帕金森病（Parkinson's disease，PD）均有明显差异，但因两者存在症状上的重叠，临床存在误诊的可能。辅助检查技术的进步有助于VaP的诊断，如头颅MRI测量尾状核、基底节及皮层下区域的白质高信号（white matter hyperintensities，WMH）体积，SWI的黑质成像均可对两者进行鉴别。另外，分子影像学和基于步态时间序列的神经网络步态模式评估等新技术也有助于对VaP和PD的区分。

关键词: 血管性帕金森综合征; 脑白质高信号; 脑小血管病; 影响因素; 磁共振成像

YE Yichao, YU Shi, SHE Yajun, FANG Zheng, WANG Yi. Progress of Vascular Parkinsonism[J]. Chinese Journal of Stroke, 2022, 17(04): 346-350.

叶益超, 玉石, 佘亚军, 方正, 王毅. 血管性帕金森综合征的研究进展[J]. 中国卒中杂志, 2022, 17(04): 346-350.

References

[1] CRITCHLEY M. Arteriosclerotic parkinsonism[J].Brain，1929，52（1）：23-83.
[2] FITZGERALD P M，JANKOVIC J. Lower body parkinsonism：evidence for vascular etiology[J].Mov Disord，1989，4（3）：249-260.
[3] KORCZYN A D. Va scula r pa rk insoni smcharacteristics，pathogenesis and treatment[J]. Nat Rev Neurol，2015，11（6）：319-326.
[4] NARASIMHAN M，SCHWARTZ R，HALLIDAY G. Parkinsonism and cerebrovascular disease[J/OL].J Neurol Sci，2021：120011[2021-12-10].https://doi.org/10.1016/j.jns.2021.120011.
[5] CHE MOHD NASSIR C M N，DAMODARAN T，YUSOF S R，et al. Aberrant neurogliovascular unit dynamics in cerebral small vessel disease：a rheological clue to vascular parkinsonism[J/OL]. Pharmaceutics，2021，13（8）：1207[2021-12-10].https://doi.org/10.3390/pharmaceutics13081207.
[6] VERKHRATSKY A，NEDERGAARD M.Physiology of astroglia[J]. Physiol Rev，2018，98（1）：239-389.
[7] SWEENEY M D，ZHAO Z，MONTAGNE A，et al. Blood-brain barrier：from physiology to disease and back[J]. Physiol Rev，2019，99（1）：21-78.
[8] LOUVEAU A，HERZ J，ALME M N，et al. CNS lymphatic drainage and neuroinf lammation are regulated by meningeal lymphatic vasculature[J].Nat Neurosci，2018，21（10）：1380-1391.
[9] DUNET V，DEVERDUN J，CHARROUD C，et al. Cognitive impairment and basal ganglia functional connectivity in vascular parkinsonism[J]. AJNR Am J Neuroradiol，2016，37（12）：2310-2316.
[10] MANTESE C E，HAINZENREDER T B. Neuromelanin accumulation in substantia nigra in vascular parkinsonism[J]. J Neural Transm（Vienna），2020，127（7）：1089-1091.
[11] SALSONE M，CALIGIURI M E，CASTRONOVO V，et al. Microst ructural changes in normalappearing white matter in male sleep apnea patients are reversible after treatment：a pilot study[J]. J Neurosci Res，2021，99（10）：2646-2656.
[12] LEE Y H，LEE S，CHUNG S J，et al. The pattern of FP-CIT PET in pure white matter hyperintensitiesrelated vascular parkinsonism[J/OL]. Parkinsonism Relat Disord，2021，82：1-6[2021-12-10]. https://doi.org/10.1016/j.parkreldis.2020.11.002.
[13] DENG Y Y，LU J，LING E A，et al. Role of microglia in the process of inf lammation in the hypoxic developing brain[J]. Front Biosci，2011，3（3）：884-900.
[14] HANYU H，ASANO T，TANAKA Y，et al . Increased blood-brain barrier permeability in white matter lesions of Binswanger's disease evaluated by contrast-enhanced MRI[J]. Dement Geriatr Cogn Disord，2002，14（1）：1-6.
[15] U D A G E D A R A T B ，DH A NA NJA L E E ALAHAKOON A M，GOONARATNA I K. Vascular parkinsonism：a review on management updates[J]. Ann Indian Acad Neurol，2019，22（1）：17-20.
[16] ZIJLMANS J C，DANIEL S E，HUGHES A J，et al. Clinicopathological investigation of vascular parkinsonism，including clinical cr iter ia for diagnosis[J]. Mov Disord，2004，19（6）：630-640.
[17] GUPTA D，KURUVILLA A. Vascular parkinsonism：what makes it different?[J]. Postgrad Med J，2011，87（1034）：829-836.
[18] FERREIRA F，GAGO M F，BICHO E，et al. Gait stride-to-stride variability and foot clearance pattern analysis in idiopathic Parkinson's disease and vascular parkinsonism[J/OL]. J Biomech，2019，92：98-104[2021-12-10]. https://doi.org/10.1016/j.jbiomech.2019.05.039.
[19] 马惠姿，张晓颖，张宁. 血管源性帕金森综合征抑郁、焦虑与其他症状的关系研究[J]. 中国卒中杂志，2018，13（7）：676-680.

[20] 中华医学会神经病学分会帕金森病及运动障碍学组，中国医师协会神经内科医师分会帕金森病及运动障碍专业委员会. 中国血管性帕金森综合征诊断与治疗专家共识[J]. 中华神经科杂志，2017，50（5）：326-331.

[21] ZHANG S，WANG Y，LIU L，et al. Case report of a pathologically confirmed vascular parkinsonism with early cognitive impairment and behavioral disturbance[J]. BMC Neurol，2021，21（1）：15.
[22] HANDLEY A，MEDCALF P，HELLIER K，et al.Movement disorders after stroke[J]. Age Ageing，2009，38（3）：260-266.
[23] VAN DER HOLST H M，VAN UDEN I W，TULADHAR A M，et al. Cerebral small vessel disease and incident parkinsonism：the RUN DMC study[J]. Neurology，2015，85（18）：1569-1577.
[24] DUNET V，DEVERDUN J，CHARROUD C，et al. MRI volumetric morphometr y in vascular parkinsonism[J]. J Neurol，2017，264（7）：1511-1519.
[25] ZHAO X J，NIU X Y，YOU H Y，et al. Signal alteration of substantia nigra on 3. 0T susceptibilityweighted imaging in Parkinson's disease and vascular parkinsonism[J]. Curr Med Sci，2019，39（5）：831-835.
[26] MA K K Y，LIN S，MOK V. Neuroimaging in vascular parkinsonism[J/OL]. Curr Neurol Neurosci Rep，2019，19（12）：102[2021-12-10]. https://doi.org/10.1007/s11910-019-1019-7.
[27] KIM B C，CHOI S M，CHOI K H，et al. MRI measurements of brainstem structures in patients with vascular parkinsonism，progressive supranuclear palsy，and Parkinson's disease[J].Neurol Sci，2017，38（4）：627-633.
[28] 李珊，马莎，王波，等. 弥散张量成像在血管性帕金森综合征及帕金森病鉴别诊断中的应用[J]. 中国老年学杂志，2021，41（22）：4993-4996.
[29] WANG H C，HSU J L，LEEMANS A. Diffusion tensor imaging of vascula r pa rkinsoni sm：structuralchanges in cerebral white matter and the association with clinical severity[J]. Arch Neurol，2012，69（10）：1340-1348.
[30] 谭晓琳，任艳，李松柏，等. 弥散张量成像在血管性帕金森综合征诊断中的应用[J]. 中国医科大学学报，2016，45（4）：361-370.
[31] FERNANDES C，FERREIRA F，LOPES R L，et al. Discrimination of idiopathic Parkinson's disease and vascular parkinsonism based on gait time series and the levodopa effect[J/OL]. J Biomech，2021，125：110214[2021-12-10]. https://doi.org/10.1016/j.jbiomech.2020.110214.
[32] CABA L M，FERRAIRó J I T，TORRES I M，et al. Increased pulsatility index supports diagnosis of vascular parkinsonism versus idiopathic Parkinson's disease[J]. Neurologia，2020，35（8）：563-567.
[33] BARBAGALLO C，MOSTILE G，BAGLIERI G，et al. Specific signatures of serum mirnas as potential biomarkers to discriminate clinically similar neurodegenerative and vascular-related diseases[J]. Cell Mol Neurobiol，2020，40（4）：531-546.
[34] ONDER H. Dramatic improvement by levodopa treatment in a patient with vascular parkinsonism[J]. Neurol Sci，2019，40（2）：423-425.
[35] JIN H Y，ZHANG J，HU Q Y，et al. Naloxone alleviate the severity of delirium in hospitalized patients with parkinsonism：three case reports[J/OL]. Front Psychiatry，2021，12：748958[2021-12-10].https://dx.doi.org/10.3389%2Ffpsyt.2021.748958.
[36] 张俊霞，徐沙丽，金俏，等. 重复经颅磁刺激联合药物治疗对血管性帕金森综合征患者运动功能的影响[J]. 中华物理医学与康复杂志，2021，43（10）：930-932.
[37] YIP C W，CHEONG P W T，GREEN A，et al. A prospective pilot study of repetitive transcranial magnetic stimulation for gait dysfunction in vascular parkinsonism[J]. Clin Neurol Neurosurg，2013，115（7）：887-891.
[38] MAKSIMOVICH I V. Intracerebral transcatheter laser photobiomodulation therapy in the treatment of Binswanger's disease and vascular parkinsonism：research and clinical experience[J]. PhotobiomodulPhotomed Laser Surg，2019，37（10）：606-614.