Clinical Diagnosis of Vascular Parkinsonism and Nondegenerative Atypical Parkinsonian Disorders

  • Madhavi Thomas
  • Joseph Jankovic
Part of the Current Clinical Neurology book series (CCNEU)


Idiopathic Parkinson’s disease (PD) is the most common cause of parkinsonism, accounting for about 75% of all cases. Other causes of parkinsonism include multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and a variety of other neurodegenerative disorders in which rest tremor, bradykinesia, rigidity, and other parkinsonian features are present. Since these disorders are often associated with other neurological deficits, such as dysautonomia (in MSA), vertical ophthalmoparesis (in PSP), and apraxia (in CBD), they are referred to as “parkinsonism plus syndromes.” Whereas the above disorders are degenerative in nature, there are other forms of parkinsonism, which are secondary to a variety of etiologic factors including vascular parkinsonism (VP), hemiatrophy hemiparkinsonism, and toxic and metabolic causes.


West Nile Virus Multiple System Atrophy Gait Disorder Postural Tremor Subacute Sclerosing Panencephalitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Gelb DJ, Oliver E, Gilman S. Diagnostic criteria for Parkinson disease. Arch Neurol 1999;56:33–39.PubMedCrossRefGoogle Scholar
  2. 2.
    Critchley M. Atherosclerotic parkinsonism. Brain 1929;52:23–83.CrossRefGoogle Scholar
  3. 3.
    Zijlmans JCM, Daniel S, Hughes AJ, Revesz T, Lees AJ. A clinicopathological investigation of vascular parkinsonism (VP). Mov Disord published online March 16, 2004.Google Scholar
  4. 4.
    Daniel SE, Lees AJ. Parkinson’s disease society brain bank, London: overview and research. J Neural Transm Suppl 1993;39:165–172.PubMedGoogle Scholar
  5. 5.
    Thompson PD, Marsden CD. Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger disease. Mov Disord 1987;2:1–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Roman GC. New insight into Binswanger disease. Arch Neurol 1999;56:1061–1106.PubMedCrossRefGoogle Scholar
  7. 7.
    Mark MH, Sage JI, Walters AS, et al. Binswanger disease presenting as levodopa responsive parkinson’s disease. Clinicopathological study of three cases. Mov Disord 1995;10:450–454.PubMedCrossRefGoogle Scholar
  8. 8.
    Chang CM, Yu YL, Ng HK Leung SY, Fong KY. Vascular pseudoparkinsonism. Acta Neurol Scand 1992;86:588–592.PubMedGoogle Scholar
  9. 9.
    Yamanouchi H, Nagura H. Neurological signs and frontal white matter lesions in vascular parkinsonism—a clinicopathological study. Stroke 1997;28:965–969.PubMedGoogle Scholar
  10. 10.
    Van Zagaten M, Lodder J, Kessels F. Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions. Mov Disord 1998;13:89–95.CrossRefGoogle Scholar
  11. 11.
    Winikates J, Jankovic J. Clinical correlates of vascular parkinsonism. Arch Neurol 1999;56:98–102.PubMedCrossRefGoogle Scholar
  12. 12.
    Dubinsky RM, Jankovic J. Progressive supranuclear palsy and a multi-infarct state. Neurology 1987;37:570–576.PubMedGoogle Scholar
  13. 13.
    Winikates J, Jankovic J. Vascular PSP. J Neural Transm Suppl 1994;42:189–201.PubMedGoogle Scholar
  14. 14.
    Fitzgerald P, Jankovic J. Lower body parkinsonism: evidence for vascular etiology. Mov Disord 1989;4:249–260.PubMedCrossRefGoogle Scholar
  15. 15.
    Jankovic J, Nutt JG, Sudarsky L. Classification, diagnosis and etiology of gait disorders. In: Ruzicka E, Hallett M, Jankovic J, eds. Gait disorders. Advanced in Neurology, vol. 87, Philadelphia: Lippincott Williams & Wilkins, 2001:119–134.Google Scholar
  16. 16.
    Demikiran M, Bozdemir H, Sarica Y. Vascular parkinsonism, a distinct heterogeneous clinical entity. Acta Neurol Scand 2001;104:63–67.CrossRefGoogle Scholar
  17. 17.
    Trenkwalder C, Paulus W, Keafeczyc S, et al. Postural stability differentiates “lower body” from idiopathic parkinsonism. Acta Neurol Scand 1995;91:444–452.PubMedCrossRefGoogle Scholar
  18. 18.
    Zijlmans JCM, Poels PJE, Duysens J, et al. Quantitative gait analysis in patients with vascular parkinsonism. Mov Disord 1996;5:501–508.CrossRefGoogle Scholar
  19. 19.
    Thomas M, Suteerawattanon M, Caroline KS, et al. Gait and Balance Scale: validation and utilization. J Neurol Sci 2004;217:89–99.PubMedCrossRefGoogle Scholar
  20. 20.
    Huang Z, Jacewicz M, Pfeiffer RF. Anticardiolipin antibody in vascular parkinsonism. Mov Disord 2002;17:992–997.PubMedCrossRefGoogle Scholar
  21. 21.
    Joutel A, Coprechot C, Ducros A, et al. Notch-3 mutation in CADASIL, a heriditary adult onset condition causing stroke and dementia. Nature 1997;383:707–710.CrossRefGoogle Scholar
  22. 22.
    Rafalowska J, Fidzianska A, Dziewulska D, et al. CADASIL: new cases and new questions. Acta Neuropathol 2003;Sep 30 Epub ahead of printGoogle Scholar
  23. 23.
    Kuhn W, Roebroek R, Blom H, et al. Elevated plasma levels of homocysteine in Parkinson’s disease. Eur Neurol 1998;40:225–227.PubMedCrossRefGoogle Scholar
  24. 24.
    Rogers JD, Sanchez-Saffon A, Frol AB, Diaz-Arrstia R. Elevated plasma homocysteine levels in patients treated with levodopa. Association with vascular disease. Arch Neurol 2003;60:59–64.PubMedCrossRefGoogle Scholar
  25. 25.
    Eadie MJ, Sutherland JM. Atherosclerosis in parkinsonism. J Neurol Neurosurg Psychiatry 1964;27:237–240.PubMedGoogle Scholar
  26. 26.
    Izelberg R, Bronstein NM, Reider I, Korczyn AD. Basal ganglia lacunes and parkinsonism. Neuroepidemiology 1994;13:108–112.CrossRefGoogle Scholar
  27. 27.
    Chang CM, Yu Yl, Ng HK, Fong KY. Vascular pseudoparkinsonism. Acta Neurol Scand 1992;86:588–592.PubMedCrossRefGoogle Scholar
  28. 28.
    Tzen KY, Lu CS, Yen TC, et al. Differential diagnosis of Parkinson’s disease and vascular parkinsonism by 99mTc-TRODAT-I.J Nuclear Med 2001;42:408–413.Google Scholar
  29. 29.
    Bencsits G, Pirker W, Asenbaum, et al. Comparison of the 123I beta-CIT snf SPECT in lower body parkinsonism and Parkinson’s disease [Abstract]. Mov Disord 1998;13(Suppl):106.Google Scholar
  30. 30.
    Zijlmans JC, de Koster A, Van’t Jof MA, et al. Proton magnetic resonance spectroscopy in suspected vascular parkinsonism. Acta Neurol Scand 1994;90:405–411.PubMedCrossRefGoogle Scholar
  31. 31.
    Tohgi H, Takahashi S, Abe T, Utsugisawa K. Symptomatic characteristics of parkinsonism and the width of substantia nigra pars compacta on MRI according to the ischemic changes in the putamen and the cerebral white matter: implications for the diagnosis of vascular parkinsonism. Eur Neurol 2001;46:1–10.PubMedCrossRefGoogle Scholar
  32. 32.
    Zijlmans JC, Pasman JW, Horstink MW, et al. EEG findings in patients with vascular parkinsonism. Acta Neurol Scand 1998;94:243–247.Google Scholar
  33. 33.
    Tolosa ES, Santamaria J. Parkinsonism and basal ganglia infarcts. Neurology 1984;34:1516–1518.PubMedGoogle Scholar
  34. 34.
    Ondo WG, Chan LL, Levy JK. Vascular parkinsonism: clinical correlates predicting motor improvement after lumbar puncture. Mov Disord 2002;17:91–97.PubMedCrossRefGoogle Scholar
  35. 35.
    Hanna P, Jankovic J, Kilkpatrick J. Multiple system atrophy: the putative causative role of environmental toxins. Arch Neurol 1999;56:90–94PubMedCrossRefGoogle Scholar
  36. 36.
    Petrovitch H, Ross GW, Abbott RD, et al. Plantation work and risk of Parkinson disease in a population-based longitudinal study. Arch Neurol 2002;59:1787–1792.PubMedCrossRefGoogle Scholar
  37. 37.
    Gorell JM, Johnson CC, Rybicki BA, et al. Occupational exposure to manganese, copper, lead, iron, mercury, and zinc and the risk of Parkinson’s disease. Neurotoxicology 1999;20:239–247.PubMedGoogle Scholar
  38. 38.
    Ngim CH, Devathasan G. Epidemiologic study on association between body burden mercury level and idiopathic Parkinson’s disease. Neuroepidemiology 1999;8:128–141.CrossRefGoogle Scholar
  39. 39.
    Langston et al, 1999; Jenner P. The contribution of the MPTP-treated primate model to the development of new treatment strategies for Parkinson’s disease. Parkinsonism Relat Disord 2003;9:131–137.Google Scholar
  40. 40.
    Langston JW, Ballard P, Tetrud J, Irwin I. Chronic parkinsonism in humans due to a product of meperidine analog synthesis. Science 1983;219:979–980.PubMedCrossRefGoogle Scholar
  41. 41.
    Langston JW, Forno LS, Tetrud J, et al. Evidence of active nerve cell degeneration in the substantia nigra of humans years after 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine exposure. Ann Neurol 1999;46:598–605.PubMedCrossRefGoogle Scholar
  42. 42.
    Gao HM, Liu B, Hong JS. Critical role for microglial NADPH oxidase in rotenone-induced degeneration of dopaminergic neurons. J Neurosci 2003;23:6181–6187.PubMedGoogle Scholar
  43. 43.
    Nelson K, Golnick J, Korn T, Angle C. Manganese encephalopathy: Utility of early magnetic resonance imaging. Br J Ind Med 1993;50:510–513.PubMedGoogle Scholar
  44. 44.
    Normadin L, Hazel AS. Manganese neurotoxicity: an update of pathophysiologic mechanisms. Met Brain Dis 2002;17:374–387.Google Scholar
  45. 45.
    Racette BA, McGee-Minnich L, Moerlein SM, et al. Welding-related parkinsonism clinical features and pathophysiology. Neurology 2001;56:8–13.PubMedGoogle Scholar
  46. 46.
    Choi IS. Parkinsonism after carbon monoxide poisoning. Eur Neurol 2002;48:30–33.PubMedCrossRefGoogle Scholar
  47. 47.
    Lee MS, Marsden CD. Neurological sequelae following carbon monoxide poisoning: clinical course and outcome according to the clinical types and brain computed tomography scan findings. Mov Disord 1994;9:550–558.PubMedCrossRefGoogle Scholar
  48. 48.
    Parkinson RB, Hopkins RO, Cleavinger HB et al.White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology 2002;58:1525–1532.PubMedGoogle Scholar
  49. 49.
    Sohn YH, Jeong Y, Kim H, et al. The brain lesion responsible for parkinsonism after carbon monoxide poisoning. Arch Neurol 2000;57:1214–1218.PubMedCrossRefGoogle Scholar
  50. 50.
    Carella F, Grassi MP, Savoiardo M, et al. Dystonic-parkinsonian syndrome after cyanide poisoning: clinical and MRI findings. J Neurol Neurosurg Psychiatry 1988;51:1345–1348.PubMedGoogle Scholar
  51. 51.
    Messing B. J Extrapyramidal disturbances after cyanide poisoning (first MRT-investigation of the brain). Neural Transm Suppl 1991;33:141–147.Google Scholar
  52. 52.
    Rachinger J, Fellner FA, Stieglbauer J, Trenler J. MR changes after acute cyanide intoxication. Am J Neuroradiol 2002;23:1398–1401.PubMedGoogle Scholar
  53. 53.
    Rosenow F, Herholz K, Lanfermann H, et al. Neurological sequelae of cyanide intoxication. The pattern of clinical, magnetic resonance imaging, and positron emission tomography findings. Ann Neurol 1995;38:825–828.PubMedCrossRefGoogle Scholar
  54. 54.
    Ley CO, Gali FG. Parkinsonian syndrome after methanol intoxication. Eur Neurol 1983;22:405–409.PubMedGoogle Scholar
  55. 55.
    Finkelstein Y, Vardi J. Progressive parkinsonism in a young experimental physicist following long term exposure to methanol. Neurotoxicology 2002;23:521–525.PubMedCrossRefGoogle Scholar
  56. 56.
    Hageman G, van Der Hock J, van Hout M, et al. Parkinsonism, pyramidal signs, polyneuropathy and cognitive decline after long term occupational solvent exposure. J Neurol 1999;246:198–206.PubMedCrossRefGoogle Scholar
  57. 57.
    Neilman J, Lang AE, Fornazzari L, Carlen PL. Movement disorders in alcoholism: a review. Neurol 1990;40:741–746.Google Scholar
  58. 58.
    Nath A, Jankovic J, Pettigrew LC. Movement disorders and AIDS. Neurology 1987;37:36–41.CrossRefGoogle Scholar
  59. 59.
    de Mattos JP, de Rosso ALZ, Correa RB, et al. Movement disorders in 28 HIV-infected patients. Arq. Neuro-psiquiatr. 2002;60:525–530.Google Scholar
  60. 60.
    Maggi P, de Mari M, Moramarco G, et al. Parkinsonism in a patient with AIDS and cerebral opportunistic granulomatous lesions. Neurol Sci 2000;21:173–176.PubMedCrossRefGoogle Scholar
  61. 61.
    Cardoso F. HIV-related movement disorders: epidemiology, pathogenesis and management. CNS Drugs 2002;16: 663–668.PubMedCrossRefGoogle Scholar
  62. 62.
    Kotsulieri E, Sopper S, Scheller C, et al. Parkinsonism in HIV dementia. J Neural Transm 2002;109:767–775.CrossRefGoogle Scholar
  63. 63.
    Czub S, Koutsilleri E, Sopper S, et al. Enhancement of CNS pathology in early simian immunodeficiency virus infection by dopaminergic drugs. Acta Neuropathol 101:85–91.Google Scholar
  64. 64.
    Sawaishi Y, Yano T, Watanabe Y, Takada G. Migratory basal ganglia lesions in subacute sclerosing panencephalitis (SSPE): clinical implications of axonal spread. J Neurol Sci 1999;168:137–140.PubMedCrossRefGoogle Scholar
  65. 65.
    Mossakowski MJ, Mathesian G. A parkinsonian syndrome in the course of subacute encephalitis. Neurology 1961;11:461–461.PubMedGoogle Scholar
  66. 66.
    Kim JS, Choi IS, Lee MC. Reversible parkinsonism and dystonia following probable mycoplasma infection. Mov Disord 1995;10:510–512.PubMedCrossRefGoogle Scholar
  67. 67.
    Savant CS, Singhal BS, Jankovic J, Khan M, Virani A. Substantia nigra lesions in viral encephalitis. Mov Disord 2003;18:213–216.PubMedCrossRefGoogle Scholar
  68. 68.
    Bosanko CM, Gilroy J, Wang A-M, et al. West Nile virus encephalitis involving the substantia nigra. Arch Neurol 2003;60:1448–1452.PubMedCrossRefGoogle Scholar
  69. 69.
    Kovacs CS, Howse DC, Yendt HR. Reversible parkinsonism induced by hypercalcemia and primary hyperparathyroidism. Arch Intern Med 1993;153:1134–1136.PubMedCrossRefGoogle Scholar
  70. 70.
    Hirooka Y, Yuasa K, Hibi K et al. Hyperparathyroidism associated with parkinsonism. Intern Med 1992;31:904–907.PubMedGoogle Scholar
  71. 71.
    Manyam BV, Walters AS, Nara KR. Bilateral striopallidodentate calcinosis: clinical characteristics of patients seen in a registry. Mov Disord 2001;16:258–264.PubMedCrossRefGoogle Scholar
  72. 72.
    Manyam BV, Walters AS, Keller IA, Ghobrial M. Parkinsonism associated with autosomal dominant bilateral striopallidodentate necrosis. Parkinsonism Relat Disord 2001;7:289–295.PubMedCrossRefGoogle Scholar
  73. 73.
    Brodaty H, Mitchell P, Luscombe G, Kwok JJ, et al. Familial idiopathic basal ganglia calcification (Fahr’s disease) without neurological, cognitive and psychiatric symptoms is not linked to the IBGC1 locus on chromosome 14q. Hum Genet 2002;110:8–14.PubMedCrossRefGoogle Scholar
  74. 74.
    Li JY, Lai PH, Chen CY, Wang JS, Lo YK. Post anoxic parkinsonism: clinical radiologic, and pathologic correlation. Neurology 2000;55:591–593.PubMedGoogle Scholar
  75. 75.
    Stephen PJ, Williamson J. Drug induced parkinsonism in the elderly. Lancet 1984;2:1082–1083.PubMedCrossRefGoogle Scholar
  76. 76.
    Rajput A, Rozdilsky B, Hornykiewicz O, et al. Reversible drug-induced parkinsonism. Clinicopathologic study of two cases. Arch Neurol 1982;39:644–646.PubMedGoogle Scholar
  77. 77.
    Montastruc JL, Llau ME, Rascol O, Senard JM. Drug induced parkinsonism: a review. Fundam Clin Pharmacol 1994;8:293–306.PubMedCrossRefGoogle Scholar
  78. 78.
    Hardie RJ, Lees AJ. Neuroleptic induced parkinson’s syndrome: clinical features and results of treatment with levodopa. J Neurol Neurosurg Psych 1988;51:850–8554.Google Scholar
  79. 79.
    Consentino C, Torres L, Scortiati C et al. Movement disorders secondary to adulterated medication. Neurology 2000;55:598–599.Google Scholar
  80. 80.
    Tolosa E, Coelho M, Gallardo M. DAT imaging in drug-induced and psychogenic parkinsonism. Mov Disord 2003;18(Suppl 7):S28–S33.PubMedCrossRefGoogle Scholar
  81. 81.
    Cardoso F, Jankovic J. Peripherally induced tremor and parkinsonism. Arch Neurol 1995;52:263–270.PubMedGoogle Scholar
  82. 82.
    Thomas M, Hayflick SJ, Jankovic J. Clinical heterogeneity of neurodegeneration with iron accumulation-1 (Hallervorden-Spatz syndrome) and pantothenate kinase associated neurodegeneration (PKAN). Mov Disord 2004;19:36–42.PubMedCrossRefGoogle Scholar
  83. 83.
    Jankovic J, Newmark M, Peter P. Parkinsonism and acquired hydrocephalus. Mov Disord 1986;1:59–64.PubMedCrossRefGoogle Scholar
  84. 84.
    Reiderer P, Foley P. Mini-review: multiple developmental forms of parkinsonism. The basis for further research as to the pathogenesis of parkinsonism. J Neural Transm 2002;109:1469–1475.CrossRefGoogle Scholar
  85. 85.
    Pranzatelli M, Mott SH, Pavlakis SG, Conry JA, Tate ED. Clinical spectrum of secondary parkinsonism in childhood: a reversible disorder. Pediatr Neurol 1994;10:131–140.PubMedCrossRefGoogle Scholar
  86. 86.
    Scott BL, Jankovic J. Delayed-onset progressive movement disorders after static brain lesions. Neurology 1996;46:68–74.PubMedGoogle Scholar
  87. 87.
    Klawans HL. Hemiparkinsonism as a late complication of hemiatrophy. Neurology 1981;31:625–628.PubMedGoogle Scholar
  88. 88.
    Buchman AS, Goetz C, Klawans HL. Hemiparkinsonism with hemiatrophy. Neurology 1988;38:527–530.PubMedGoogle Scholar
  89. 89.
    Jankovic J. Hemiparkinsonism and hemiatrophy. Neurology 1988;38:1815.PubMedGoogle Scholar
  90. 90.
    Greene PE, Bressman SB, Ford B, Hyland K. Parkinsonism, dystonia, hemiatrophy. Mov Disord 2000;15:537–541.PubMedCrossRefGoogle Scholar
  91. 91.
    Lang AE. Hemiatrophy, Juvenile-onset exertional alternating leg paresis, hypotonia, and hemidystonia and adult-onset hemiparkinsonism: the spectrum of Hemiparkinsonism-Hemiatrophy syndrome. Mov Disord 1995;10:489–494.PubMedCrossRefGoogle Scholar
  92. 92.
    Marchioni E, Soragna D, Versino M et al. Hemiparkinsonism-hemiatrophy with brain hemihypoplasia. Mov Disord 1999;14:359–363.PubMedCrossRefGoogle Scholar
  93. 93.
    Siderowf AD, Galetta SL, Hurtig HI, Liu GT. Mov Disord 1998; 13:170–174.PubMedCrossRefGoogle Scholar
  94. 94.
    Cicarelli G, Pelecchia MT, Maiuri F, Barone P. Brain stem cystic astrocytoma presenting with pure parkinsonism. Mov Disord 1999;14:364–366.PubMedCrossRefGoogle Scholar
  95. 95.
    Wenning GK, Luginger E, Sailer U, et al. Postoperative parkinsonian tremor in a patient with a frontal meningioma. Mov Disord 1999;14:366–368.PubMedCrossRefGoogle Scholar
  96. 96.
    Ling M, Aggrawal A, Morris JGL. Dopa-responsive parkinsonism secondary to right temporal lobe hemorrhage Mov Disord 2002;17:402–403.PubMedCrossRefGoogle Scholar
  97. 97.
    Pohle T, Krauss J. Parkinsonism in children resulting from mesencephalic tumors. Mov Disord 1999;14:842–846.PubMedCrossRefGoogle Scholar
  98. 98.
    Leopold NA, Bara-Jimenez W, Hallett M. Parkinsonism after a wasp sting. Mov Disord 1999;14:122–127.PubMedCrossRefGoogle Scholar
  99. 99.
    Folgar S, Gatto EM, Raina G, Micheli F. Parkinsonism as a manifestation of multiple sclerosis. Mov Disord 2003;18:108–113.PubMedCrossRefGoogle Scholar
  100. 100.
    Clifford DB, McArthur JC, Schifitto G. A randomized clinical trial of CPI-1189 for HIV-associated cognitive-motor impairment. Neurology 2002;59:1568–1573.PubMedGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Madhavi Thomas
    • 1
  • Joseph Jankovic
    • 2
  1. 1.Experimental Therapeutics Branch, National Institutes of Neurologic Disorders and StrokeNational Institutes of HealthBethesda
  2. 2.Parkinson’s Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHouston

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