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Original Paper

Symptomatic Characteristics of Parkinsonism and the Width of Substantia nigra pars compacta on MRI According to Ischemic Changes in the Putamen and Cerebral White Matter: Implications for the Diagnosis of Vascular Parkinsonism

Tohgi H. · Takahashi S. · Abe T. · Utsugisawa K.

Author affiliations

Department of Neurology, Iwate Medical University, Morioka, Japan

Related Articles for ""

Eur Neurol 2001;46:1–10

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: July 12, 2001
Issue release date: July 2001

Number of Print Pages: 10
Number of Figures: 3
Number of Tables: 4

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE

Abstract

To investigate the significance of vascular lesions as a cause of secondary parkinsonism, we analyzed the symptomatic characteristics, the width of the substantia nigra pars compacta (SNpc) on MRI and the responsiveness to L-dopa in 227 parkinsonian cases, excluding those with drug-induced parkinsonism and neurodegenerative diseases other than idiopathic Parkinson’s disease (IPD). They were classified into those without a significant infarct in the basal ganglia (n = 144), those with status lacunaris in the putamen (SLP; n = 66) and those with confluent white matter hyperintensity signals (CWMH; n = 17). The 4- to 6-Hz tremor and cogwheel rigidity were significantly more frequent in cases without significant infarct (69%) than those with SLP (50%) and those with CWMH (12%; p < 0.05). Among cases with 4- to 6-Hz tremor and cogwheel rigidity, the frequency of patients with a reduced SNpc width and L-dopa responders did not significantly differ between those with SLP (73 and 83%, respectively) and those without significant infarct (83 and 86%, respectively), suggesting that the diagnosis for most of these cases would be probable IPD. In contrast, among cases without 4- to 6-Hz tremor and cogwheel rigidity, those with a reduced SNpc width or L-dopa responders were significantly less frequent among cases with SLP (25 and 38%, respectively) than among those without significant infarct (75 and 71%, respectively; p < 0.05). Patients with neither 4- to 6-Hz tremor and cogwheel rigidity nor reduction in the SNpc width, for whom the probable diagnosis was vascular parkinsonism (VP), were significantly more frequent in cases with SLP (26%) and with CWMH (40%) than those without significant infarct (8%), accounting for 10.6% of the total parkinsonian cases. These findings suggest that parkinsonian cases with SLP or CWMH consist of not only cases with vascular-lesion-related VP but also IPD in which vascular lesions are not directly related to parkinsonism. Absence of 4- to 6-Hz tremor, cogwheel rigidity and the reduction in the SNpc width could be indicators for differentiating VP from IPD.

© 2001 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: July 12, 2001
Issue release date: July 2001

Number of Print Pages: 10
Number of Figures: 3
Number of Tables: 4

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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