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Vascular Parkinsonism

Parkinsonism is an umbrella term that covers a range of conditions, including Parkinson's Disease, that share similar symptoms inlcuding slow movement, rigidity (stiffness) and problems with walking. There are various types of Parkinsonisms, but today we will be talking about Vascular Parkinsonism.


Vascular parkinsonism accounts from 4.4% to 12% of all causes of parkinsonism. It is primarily caused by one or more small strokes in the brain. When we have a stroke, we lose blood flow to certain parts of our brain, depending on what arteries were impacted during the stroke. 





How is it diagnosed?

Doctors diagnose vascular parkinsonism with an examination (observing movement symptoms and walking changes, for example) and a brain imaging study (CT scan or MRI) that shows small strokes in the brain areas that control movement. Brain scans also can help exclude other conditions that look similar. For example, people with normal pressure hydrocephalus can experience walking and other changes, but these are due to the brain’s fluid-filled spaces expanding.




What are the similarities between vascular parkinsonism and PD?

Typically, vascular parkinsonism impacts a person's lower body, but this will all be dependent on where in the brain the stroke occured. People with vascular parkinsonism often experience a “lower body parkinsonism” and have trouble with walking and maintaining balance.


Other common symptoms can include problems with memory, sleep, and mood. Many people with PD experience these nonmotor symptoms too!




What makes vascular parkinsonism different from PD?

Vascular parkinsonism is caused by one or small strokes and PD is caused by a gradual loss of nerve cells. Therefore, PD is thought to be progressive while vascular parkinsonism is not thought to be progressive. Vascular parkinsonism can still progress if there are more strokes or other changes to the circulation going to the brain. People with vascular parkinsonism might report an abrupt onset of symptoms or stepwise deterioration (occurring <1 year after the stroke) because of this.


People with vascular parkinsonism generally do not respond well to current PD medications.


People with vascular parkinsonism are less likely to have tremor similar to PD.




Treatment

Treatment is a big difference between PD and vascular parkinsonism. One of the important parts of treatment involves targeting stroke risk factors. This involves checking and treating for high blood pressure, high cholesterol, diabetes, and to educate on the importance of stopping any tobacco use and promoting a more active lifestyle.



With motor symptoms of vascular parkinsonism, physical and occupational therapy are the main treatments. Pharmacological treatments are less effective and typically do not offer significant benefit.




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