Subcortical arteriosclerotic encephalopathy: a clinical and radionuclide brain scintiscan study

Vascular pseudoparkinsonism

Vascular pseudoparkinsonism may be confused with idiopathic Parkinson's disease. Patients may be unnecessarily treated with anti-parkinsonian drugs while their underlying vascular disease is ignored. We investigated 250 parkinsonian patients seen in our Movement Disorders Clinic for a possible vascular etiology. After excluding those with a known secondary cause such as drug-induced parkinsonism, progressive supranuclear palsy, multiple system atrophy and hyperparathyroidism, brain computed tomography and/or magnetic resonance imaging were performed on those who showed poor or no response to levodopa. In those with an ischemic lesion demonstrated on neuroimaging, anti-parkinsonian drugs were stopped and the patients were reassessed. Eleven patients (4.4%) had ischemic brain lesions accounting for their parkinsonism. All were initially diagnosed as Parkinson's disease because of the prominence of bradykinesia and rigidity. Gait disturbance was also common, but resting tremor was distinctly absent. Three anatomical patterns with different prognosis were identified. Three patients with basal ganglia lacunar infarct recovered spontaneously, three with frontal lobe infarcts remained static and five with periventricular and deep subcortical white matter lesions had progressive deterioration. Autopsy in one patient confirmed bilateral frontal lobe watershed infarcts and the absence of brain stem Lewy bodies. Parkinsonian patients with poor or no response to levodopa therapy should be investigated for a vascular etiology.

Subcortical arteriosclerotic encephalopathy--a controlled psychometric study

Eleven patients with subcortical arteriosclerotic encephalopathy (SAE) were assessed psychometrically, and the results compared with control subjects without neurological disorders and patients with a single cerebral vascular lesion (CVL). The groups were matched for sex, age, years of education, and in addition for the CVL group, the nature, site and size of the discrete vascular lesion. The SAE patients had mild to moderate impairment in intellectual, memory, receptive language and constructional functions, but individual performance ranged from near normality to severe impairment. The differences between the performance of SAE patients and the controls were significant in the majority of tests. The SAE patients had lower scores than CVL patients on all tests, but in many of these the difference was not significant.