老年人血管性帕金森综合征与帕金森病合并脑梗死影像与临床对比史洪润

目的探讨老年人血管性帕金森综合征(VP)影像和临床特点，及其与帕金森病合并脑梗死(PDCI)的区别。方法对47例VP及30例PDCI住院或长期门诊随访的老年患者的影像学检查结果及临床表现进行比较分析。结果VP组影像学主要表现为多发基底节(70.2%)、脑室周围腔隙性脑梗死(48.9%)，且以双侧多见，分别占相应部位的70%和74%；常伴脑萎缩、白质疏松。其影像学改变与PDCI患者无显著差别。VP患者多以僵直-少动起病(74.5%)，而PDCI患者多以震颤或震颤-僵直-少动起病(76.7%)。临床上VP患者以对称性铅管样肌僵直-少动为主，静止性震颤少见；可伴锥体束损害表现、智能障碍和尿失禁。上述表现与PDCI组比较差异有显著性。两组中，有智能障碍者伴基底节、脑室周围腔隙性梗死或脑萎缩者均较伴白质疏松者多见，且以双侧为主。结论老年人VP影像学改变主要为基底节、脑室周围多发腔隙性梗死，常伴脑萎缩、白质疏松；VP患者临床表现与PDCI患者不同;基底节、脑室周围多发腔隙性梗死与VP患者的临床表现相关。

Comparative analysis of the imaging changes and the clinical manifestations between vascular parkinsonism and Parkinson's disease with cerebral infarction in elderly patients

Objective　To explore the imaging changes and clinical features in vascular parkinsonism (VP) and the differences between VP and Parkinson's disease with cerebral infarcts(PDCI) in elderly patients. 　Methods　 Imaging changes and clinical manifestations were retrospectively investigated in hospitalized or following-up elderly patients with VP(n=47) and PDCI (n=30). 　Results　 Imaging changes mainly displayed multiple lacunar infarcts in basal ganglia (70.2%) and periventrical cerebral white matter (48.9%), and frequently accompaning with cerebral atrophy or leucoaraiosis in VP group. Most of infarcts were bilateral, occuping 70% and 74% of the regions, respectively. There showed no statistical difference in imaging changes between VP and PDCI. VP was clinically characterized by frequent rigidity-hypokinesia onset, symmetrical lead-pipe rigidity, and infrequent resting tremor. Parts of VP patients had signs of pyramidal tract disorders, including intellect impairment and urine incontinence. All these features in VP group were remarkable, differing from those in PDCI group(P＜0.05～0.001). Most of patients with intellect impairment in two groups displayed bilateral lacunar infarcts in basal ganglia and periventrical white matter. 　Conclusions　 Multiple lacunar infarcts in basal ganglia and periventrical cerebral white matter plays an important role in imaging change in elderly patient with VP and were related to clinical manifestation of VP. Clinical features of VP differred from that of PDCI.