血管性帕金森综合征的临床与影像学分析

目的　探讨血管性帕金森综合征 (VP)的临床和影像学特点。方法　对 5 0例VP及 118例帕金森病 (PD)住院或长期门诊随访患者临床及影像学表现 ,进行归纳分析和统计学处理 ;并与 31例帕金森病合并脑梗死 (PDCI)者对照。结果　VP发病年龄大于PD ;多伴长期高血压 ;以肌强直 少动起病者多见 ;临床上以对称性铅管样肌强直 少动为主 ,静止性震颤少见 ;可伴锥体束损害表现和智能障碍、尿失禁。PD和PDCI多以震颤起病 ;常有静止性震颤 ;非对称齿轮样肌强直多见。VP影像学主要表现为多发基底节 (72 % )、脑室周围腔梗 (5 2 % ) ,且双侧多见 ,分别占相应部位的 6 9%和 73%。结论　VP发病与长期高血压有关 ;基底节、脑室周围多发腔梗是导致VP的主要原因 ;VP临床表现不同于PD或PDCI;出现PD表现后 ,及时MRI或CT检查具有十分重要的鉴别意义。

Contrasting clinical and imaging analysis of vascular parkinsonism

Objective To explore clinical features of vascular parkinsonism (VP) and difference between VP,Parkinson's disease (PD) and PD with cerebral infarcts (CI).Methods Clinical manifestations and imaging changes were retrospectively investigated in hospitalized or following up cases of VP(n=50),PD (n=118) and PD with CI (n=31).Results Age at onset in VP patients was older than that in PD.Most of VP patients were accompanied by chronic hypertension (n=28,56%).Case control study showed that hypertension at study entry was associated with pathogenesis of VP (OR 6.31,95% confidence interval [CI] 3.316～ 12.716; Attributable fractions for the exposed population [ARP] 0.842,95%CI 0.681～0.921;Prevented attributable for the total population [PARP] 0.471;χ 2=29.47,P<0.0001).VP was characterized clinically by frequent rigidity hypokinesia onset,symmetrical lead pipe rigidity,and infrequent resting tremor.Part of VP patients demonstrated pyramidal tract damage sign,memory and intellect impairment,or incontinence of urine.However,clinical features of PD were revealed by usual rest tremor at onset,asymmetrical cog wheel rigidity,frequent resting tremor,and absence of pyramidal tract damage sign.Core imaging changes were multiple lacunar infarcts in basal ganglia and periventricular cerebral white matter.Conclusions Hypertension played an important role in the pathogenesis of VP.Clinical manifestations of VP were different from those typical for PD and PD with CI.MRI or CT features were different between VP and PD.Once parkinsonism appears,MRI or CT examination has important differentiating significance.