血管性帕金森综合征

随影像学发展和尸解病例增多，血管性帕金森综合征已渐为人们所认识。本对血管性帕金森综合征的病因、发病机制、病理改变、临床表现、血液流变学、经颅多普勒、头颅ＣＴ、ＭＲＩ改变、，诊断一鉴别诊断以及治疗和康复等研究进展进行综述。     

血管性帕金森综合征46例分析

目的：探讨血管性帕金森综合征（VP）的临床特点、发病机理、诊断与治疗。方法：46例符合血管性帕金森综合征的脑梗死患者进行归纳、分析。结果：VP患者以强直性肌张力增高、慌张步态为主．伴有锥体束征、假性球麻痹及智能障碍。头部CT显示基底节多发性腔隙性梗死、局限性或普遍性脑萎缩。结论：VP的临床诊断应结合病史、临床表现、影像学改变及对多巴胺制剂的疗效，基础治疗结合抗凝和改善微循环等综合治疗可能有效。     

血管性帕金森综合征103例临床表现与影像学分析

目的:对103例血管性帕金森综合征患者的临床表现及影像学(头颅CT、MRI)特点进行分析总结。方法:回顾性分析103例血管性帕金森综合征患者的临床及影像学资料。结果:①血管性帕金森综合征发病年龄高峰为60～79岁,临床表现较急,以运动减慢-强直、球麻痹为主要临床表现,锥体束损害表现明显,而静止性震颤少见;②伴发的高危因素中,以高血压、糖尿病为最多见,且较高比例的患者存在血脂增高和C反应蛋白指数增高;③经头CT、MRI影像学检查血管性帕金森综合征患者可见明显的影像学异常,主要以腔隙性脑梗死为主(88.3%),部位可位于单侧、双侧基底节或额叶白质,部分病例在大脑脚、侧脑室旁可见缺血性改变。结论:血管性帕金森综合征起病形式较急,多伴有脑血管病的高危因素,头影像学有明显的缺血改变。     

帕金森病和血管性帕金森综合征的头颅MRI影像特征对比观察

目的:探讨帕金森病和血管性帕金森综合征的头颅MRI影像特征对比。方法:选取2016年02月至2018年08月收治的研究对象为15例帕金森病--观察组,同期选择15例血管性帕金森综合征患者作为研究对象--对照组,均采用头颅MRI检查,且对检查后黑质致密带宽度值、中脑直径及黑质致密带宽度值/中脑直径比值、影像学表现进行观察及分析。结果:观察组黑质致密带宽度值、中脑直径及黑质致密带宽度值/中脑直径比值均低于对照组数据,P值小于0.05。两组患者在正常、基底节区病变、皮层下白质病变、脑萎缩、脑叶损害及脑干损伤对比中存在明显差异,P值小于0.05,于丘脑损害及小脑损伤对比中无明显差异,P值大于0.05。结论:头颅MRI影像特征可在帕金森病与血管性帕金森综合征鉴别诊断中发挥重要作用,即帕金森病以正常老化改变为主,而血管性帕金森综合征以多发性腔隙性脑梗死为主,只有医务人员完全掌握以上两种疾病的磁共振特征,才能进一步提高诊断确诊率。     

帕金森病与血管性帕金森综合征患者血清同型半胱氨酸水平的临床对比

目的探讨血清同型半胱氨酸(Hcy)的水平与帕金森病和血管性帕金森综合征的相关性。方法检测38例帕金森病患者和42例血管性帕金森综合征患者及50例健康老人的血清Hcy水平。结果帕金森病组患者血清Hcy水平(26.17±2.29)μmol/L及血管性帕金森综合征组患者血清Hcy水平(25.43±1.57)μmol/L明显高于正常老年人组(13.29±2.13)μmol/L,差异有统计学意义(P<0.01),结论血管性帕金森综合征与帕金森病均会出现血清同型Hcy水平升高,高同型半胱氨酸血症可能参与血管性帕金森综合征和帕金森病的发生发展过程。     

老年人血管性帕金森综合征36例分析

血管性帕金森综合征(VPS)是由于脑血管性病变引起的一类继发性帕金森综合征.多见于老年人,患者常有高血压病、脑中风病史.以往仅凭病史及临床表现有时难与原发性帕金森病(IPD)鉴别,近年由于电子计算机断层扫描(CT)和磁共振成像(MRI)诊断技术的临床应用,使VPS的检出率逐渐增加.本文结合我院36例VPS患者临床特征、影像学检查结果进行分析,对其发病机制及诊治进行探讨,现报道如下.     

育阴活血法治疗血管性帕金森综合征38例

血管性帕金森综合征是在原有脑血管病基础上出现的以“肌强直、运动减少、姿势反射异常”等临床表现。在病理上多见壳核、苍白球多发性小梗塞灶，而无帕金森病所见到的那样明显的黑质细胞脱落的一种类型的帕金森综合征。本病震颤症状出现甚少，即使出现。也更近似老年性震颤。1998～2005年，本人单独应用育阴活血法治疗38例血管性帕金森综合征病人，取得较好疗效，现报告如下：     

脑梗死患者血管性假性帕金森综合征的康复

血管性假性帕金森综合征在脑梗死患者中并不少见,由于其往往并发于脑血管病患者,临床上常出现类似于脑梗死所致的口齿不清、言语困难、行动迟缓、步态障碍等神经功能缺损症状,因此常误诊为脑梗死所致的神经功能障碍。正确认识血管性假性帕金森综合征对脑血管病患者的康复治疗有重要意义。我院1993年～1997年接收脑梗死康复治疗的250例患者中,发现存在血管性假性帕金森综合征患者20例,现将有关情况报告如下。资料与方法1.1.一般资料　20例患者中,男性14例,女性6例;年龄60～79岁,平均为65.4岁。其脑梗死均经颅脑ＣＴ或核磁共振检查证实,其中基…     

磁敏感加权成像与磁共振弥散张量成像对帕金森综合征的诊断价值

目的探讨磁敏感加权成像(SWI)与磁共振弥散张量成像(DTI)对帕金森综合征的诊断价值。方法我院收治的帕金森综合征患者60例,随机数字表法分组,其中帕金森病(PD)组和血管性帕金森综合征(VP)组各30例,同期健康体检者作为对照组30例。均采用SWI与DTI检查,观察3组黑质致密带、壳核、苍白球黑质网状带、红核、尾状核头的SWI中相位值,观察3组在DTI中双侧基底核区、双侧额叶、双侧丘脑区的各向异性分数值(FA)和表观扩散系数值(ADC)。结果黑质致密带、壳核、苍白球的相位值比较,PD组小于VP组和对照组(P005),VP组与对照组比较,差异无统计学意义(P005)。对照组、VP组、PD组的双侧基底核区、丘脑区、额叶区的FA值逐渐下降,差异有统计学意义(P005)。3组双侧基底核区、双侧丘脑区、双侧额叶区的ADC值从大到小依次为对照组、VP组、PD组,差异有统计学意义(P005)。SWI联合DTI诊断帕金森综合征的特异度、敏感度高于单独诊断(P005)。结论 SWI与DTI对帕金森综合征的诊断具有重要的参考价值,两者联合检测,灵敏度和特异度明显增高。     

丁苯酞联合美多巴治疗血管性帕金森综合征的疗效观察

目的:评估丁苯酞联合美多巴治疗血管性帕金森综合征的临床疗效。方法:134例血管性帕金森患者随机分为血栓通组(n=42)、丁苯酞组(n=48)和美多巴组(n=44),分别给予复方血栓通胶囊和美多巴片、丁苯酞胶囊和美多巴片和美多巴片,疗程均为16周;并于治疗4、6、16周后观察临床疗效。结果:与美多巴组相比,各治疗组UPDRS评分均明显下降(P0.05),临床疗效明显提高(P0.01);丁苯酞组显效率及总有效率均明显优于血栓通组(P0.05)。结论:丁苯酞联合美多巴治疗血管性帕金森综合征的效果满意,建议推广应用。     

常染色体显性遗传伴外显不全帕金森综合征

目的:确定常染色体显性遗传伴外显不全帕金森综合征的临床特点.方法:详细询问家系的病史,检查症状、体征及疗效等临床特点并与青年型常染色体隐性遗传帕金森综合征做对照.结果:常染色体显性遗传伴外显不全帕金森综合征与常染色隐性遗传帕金森综合征的临床特点有明显差异.结论:对青年型家族性帕金森综合征应早期鉴别诊断,指导该病的临床及基因治疗.     

Increased risks of parkinsonism in the 3 years after chronic renal failure

Aims: Movement disorders are one of the central nervous system complications in uremic patients. Asterixis, multifocal myoclonus, and restless leg syndrome are well‐documented in this category. Acute parkinsonism, however, is only reported in rare series with a small number of cases. In this study, we investigated the risk for parkinsonism during a 3‐year follow‐up period after a diagnosis of uremia. Methods: The Longitudinal Health Insurance Database in Taiwan was utilised. We identified a total of 2862 patients who had visited ambulatory care centers with a diagnosis of chronic renal failure between 1999 and 2001 as the study cohort. We further randomly selected 14,310 enrollees matched with the study cohort in terms of gender, age, and year of their index visit for comparison. Each patient was individually tracked for 3 years to identify the occurrence of parkinsonism. Stratified Cox proportional hazard regressions (stratified by age and gender) were performed for analyses. Results: We found the annual incidence rates of parkinsonism to be 1.2% and 0.6% in the uremic and non‐uremic groups, respectively. Furthermore, uremic patients were more vulnerable to developing parkinsonism with a 1.81‐fold higher risk [95%CI = (1.21–2.71)] than the non‐uremic group after adjusting for diabetes mellitus, which did not augment the risk. Conclusions: The importance of raising awareness regarding the early symptoms of parkinsonism among patients with uremia is tied to its early identification, with timely aggressive dialysis being able to apply to slow the progression of the disease and its symptoms. Further study is warranted to elucidate the pathophysiology of uremic parkinsonism.     

Diagnosing non-parkinson's movement disorders

The risk of developing a movement disorder increases with age. Idiopathic Parkinson's disease (IPD), is probably the most well known. However, essential tremor is the most common movement disorder affecting older people. Although many sufferers can have very disabling symptoms it can be a very mild illness in some. Patients present with a symmetrical tremor of the upper limbs in 95% of cases. The tremor is less evident at rest, unlike the tremor of IPD, and there will be no rigidity or bradykinesia. Essential tremor is a mainly clinical diagnosis. A watchful waiting period may be tried. DaTSCAN can be helpful as the results will be normal in patients with essential tremor and abnormal in those with IPD. Vascular parkinsonism accounts for 4.4-12% of all cases of parkinsonism, although it is likely that many cases remain undiagnosed. The features are usually bilateral and symmetrical and often affect the lower more than the upper limbs. A history of previous stroke is common, as are the presence of cardiovascular risk factors such as hypertension and diabetes. Drug-induced parkinsonism is the second most common cause of parkinsonism behind IPD. All patients thought to have a diagnosis of possible IPD should be referred to secondary care. It would also be prudent to refer any patients whose diagnosis is unclear and where advice would be helpful on future management.     

FDG PET in the differential diagnosis of parkinsonian disorders

The differential diagnosis of parkinsonian disorders can be challenging, especially early in the disease course. PET imaging with [(18)F]-fluorodeoxyglucose (FDG) has been used to identify characteristic patterns of regional glucose metabolism in patient cohorts with idiopathic Parkinson's disease (PD), as well as variant forms of parkinsonism such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBGD). In this study, we assessed the utility of FDG PET in the differential diagnosis of individual patients with clinical parkinsonism. 135 parkinsonian patients were referred for FDG PET to determine whether their diagnosis could be made accurately based upon their scans. Imaging-based diagnosis was obtained by visual assessment of the individual scans and also by computer-assisted interpretation. The results were compared with 2-year follow-up clinical assessments made by independent movement disorders specialists who were blinded to the original PET findings. We found that blinded computer assessment agreed with clinical diagnosis in 92.4% of all subjects (97.7% early PD, 91.6% late PD, 96% MSA, 85% PSP, 90.1% CBGD, 86.5% healthy control subjects). Concordance of visual inspection with clinical diagnosis was achieved in 85.4% of the patients scanned (88.4% early PD, 97.2% late PD, 76% MSA, 60% PSP, 90.9% CBGD, 90.9% healthy control subjects). This study demonstrates that FDG PET performed at the time of initial referral for parkinsonism accurately predicted the clinical diagnosis of individual patients made at subsequent follow-up. Computer-assisted methodologies may be particularly helpful in situations where experienced readers of FDG PET images are not readily available.     

多系统萎缩患者的临床特点分析

目的 研究不同亚型多系统萎缩(multiple system atrophy,MSA)患者的临床特点.方法 回顾分析2009年1月-2011年1月收治的105例"很可能的"MSA患者的临床资料,包括发病年龄、首发症状、临床表现、治疗反应性等.结果 105例MSA患者中,男57例,女48例,发病年龄58岁.以小脑性共济失...     

Progressive supranuclear palsy-like parkinsonism resulting from occupational exposure to lead sulphate batteries

A 53-year-old man who had worked for 17 years manufacturing car batteries, with overt exposure to lead, developed a clinical picture initially characterized by signs of parkinsonism, followed by atypical signs such as loss of memory, reduction of eye movement, dysarthria, chorea-like dyskinesia and sexual impotence. The diagnosis of atypical parkinsonism was eventually changed to progressive supranuclear palsy-like parkinsonism. The patient was treated with various anti-Parkinson's disease drugs, including levodopa, with modest improvement. The symptoms deteriorated progressively, leading to permanent occupational disability with noticeable limitation of daily activities. Toxicological studies revealed abnormally high blood levels of lead. Discontinuation of lead exposure was followed first by clinical stabilization and then steady improvement. This case confirms recent reports that link exposure to lead and its compounds with degenerative diseases of the central nervous system, such as Parkinson's disease.     

Time course of tolerance to apomorphine in parkinsonism.

We sought to determine if tolerance developed to the antiparkinsonian effects of apomorphine and, if so, what temporal factors influenced its development. Seven patients with parkinsonism and motor fluctuations received short (6-hour) and long (22- to 31-hour) apomorphine infusions. Tolerance was evaluated by comparison of the responses to test doses of apomorphine that were administered before and after each infusion. The responses to the test doses that followed either infusion were reduced by 35% after the short infusion and by 68% after the long infusion, although plasma apomorphine levels were similar to or higher than levels achieved with preinfusion test doses. The duration of improvement in parkinsonism after discontinuation of the long infusion was briefer than that after the short infusion. We conclude that tolerance to apomorphine occurs in parkinsonism, and the loss of response is greater after longer periods of drug administration.     

Methanol poisoning: diagnosis and management. A case report

Methanol poisoning is an uncommon but potent central nervous system toxin. The diagnosis and the management of its sequelae remain a challenge to clinicians. A case is hereby presented in which computed tomography of the brain played an important role in making the diagnosis due to poor patient's history and unavailability of methanol assay. Parkinsonism and visual sequelae are well-recognised complications in the survivors. This patient developed parkinsonism in the form of mainly severe tremors and mild rigidity. He benefited from treatment on amantadine.     

Survival and Progression in Synucleinopathy Phenotypes With Parkinsonism: A Population-Based Study

ObjectiveTo compare survival by the presenting parkinsonism symptoms at diagnosis among patients with incident clinically diagnosed synucleinopathies.Patients and MethodsUsing the Rochester Epidemiology Project medical records–linkage system, we identified all persons residing in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from January 1, 1991, through December 31, 2010. A movement disorder specialist reviewed the complete medical records of each individual to confirm the presence of parkinsonism, determine the type of synucleinopathy, and identify the onset dates of each cardinal symptom (tremor at rest, bradykinesia, rigidity, and impaired postural reflexes). We determined the median time from age at diagnosis to death or censoring (June 30, 2015) for each presenting symptom and the age- and sex-adjusted risk of death.ResultsFrom 1991 through 2010, a total of 433 individuals had a synucleinopathy diagnosed (301 [69.5%], Parkinson disease; 68 [15.7%], dementia with Lewy bodies; 52 [12.0%], Parkinson disease dementia; and 12 [2.8%], multiple systems atrophy with parkinsonism). Overall, the risk of death in the tremor-predominant group was less than that in the bradykinesia/rigidity-only group (hazard ratio [HR], 0.59; 95% CI, 0.40-0.87; P=.007). Similarly, risk of death in the bradykinesia/rigidity-only group was significantly greater than in the tremor-predominant group (HR, 1.75; 95% CI, 1.23-2.51; P=.002) and compared with tremor before bradykinesia (HR, 1.75; 95% CI, 1.24-2.47; P=.001).ConclusionPatients with tremor as a presenting symptom have longer survival. In contrast, the presence of bradykinesia/rigidity as a presenting symptom correlates with reduced survival across all types of synucleinopathies.