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Vascular parkinsonism (VP) is a form of secondaryparkinsonism resulting from
ischaemic cerebrovascular disease. For a clinician, the most important aspect of
VP should be its differentiation from Parkinsons disease (PD). The clinical
features of VP are most helpful in making this distinction. The clinical diagnosis
of VP is most often supported by radiological studies which have evolved over the
last two decades from CT to MRI and dopamine transporter single photon
emission CT scan (DATSPECT). A clinical criterion for diagnosis of VP has also
been proposed.1 However, one aspect of VPdits pathophysiologydis still not
completely understood. This article attempts to delineate the clinical and
radiological features of VP and discusses the present evidence regarding its
pathogenesis and treatment.
BAB II
PEMBAHASAN
A.
Definisi
Parkinsonism is a syndrome that features bradykinesia (slowness of
the initiation of voluntary movement) and at least 1 of the following
conditions: rest tremor, muscular rigidity, or postural instability. In 1929,
Critchley1 identified a type of parkinsonism caused by cerebrovascular
disease in his report on arteriosclerotic parkinsonism. It required the
development of computed tomography (CT) and magnetic resonance
imaging (MRI) 50 years later to find evidence for Critchleys ideas and
what is now commonly known as vascular parkinsonism (VP).26
Ischemic vascular lesions that may lead to VP are lacunar infarctions,
white matter hyperintensities, and less common large vessel infarctions. A
comparison of 5 different European studies showed a prevalence rate of
3% of VP.7 In case the onset of parkinsonism was associated with a
cerebrovascular event, VP was diagnosed. Probably the real prevalence is
higher because only few patients with VP have an acute onset
B. Epidemiologi
VP has been reported to account for 2.5e5% of the total cases of
parkinsonism in various population based studies and clinic cohorts. The
Rotterdam study was a prospective population based cohort study in
which, of the total 132 subjects with parkinsonism, 5% had parkinsonism
cause
parkinsonism.
Although
striatal,
lenticular,
thalamic,
mesencephalic and frontal lobe infarcts have been reported to cause VP, all
infarcts at these sites do not lead to VP since asymptomatic basal ganglia
infarcts and white matter hyperintensities are a known occurrence. Lee et
al found that in a cohort of 994 asymptomatic, 20- to 78-year-olds, silent
infarcts were present on MRI in 5.84% of subjects. The most frequent sites
were basal ganglia (46/121 silent infarcts), periventricular white matter
(31/121), cerebral cortex, thalamus (15/121), pons, and cerebellum. Old
age and hypertension were independent risk factors for these silent
infarcts. Uehara et al performed brain MRIs on 219 adults, aged 33e83
years, without a history of stroke or transient ischaemic attacks and
diabetes
g. History of stroke
h. Acute onset
i. Rapid progression
j. Poor response to dopaminergic therapy
F. Gejala Klinis
Pasien dengan parkinsonisme vaskuler mungkin memiliki gejala yang sama
seperti orang-orang dengan penyakit Parkinson idiopatik , meskipun sering
melibatkan
bagian
tubuh
yang
bawah
daripadabagian
tubuh
atas,
I. Pemeriksaan Penunjang
The appropriate choice of therapy for VP depends on the
pathogenesis. If the lesions affect the nigrostriatal pathways, dopaminergic
therapy should be beneficial, but such cases are a minority. For most
patients, in whom the damage does not affect these pathways, current
therapeutic approaches are disappointing. Levodopa, dopamine agonists
and other traditional antiparkinsonian drugs are ineffective for VP that is
caused by WMLs. Subthalamic nucleus stimulation is similarly
ineffective,59 and physicaltherapy is also of limited value, although wellcontrolled studies have not been conducted. Therapy that minimizes the
vascular risk factors is expected to slow down the rate of decline, but no
studies have yet tested this hypothesis. Atherosclerotic brain disease is
common among elderly individuals, and can also affect patients with
idiopathic PD. These patients with so-called mixed disease are likely to
respond to dopaminomimetic therapy, but to a lesser extent than patients
with idiopathic PD and no atherosclerotic brain disease. An intriguing
therapeutic option that has been suggested for VP is CSF drainage. This
approach is often used to treat normal pressure hydrocephalus (NPH), a
condition with similar symptoms to VP and Binswanger disease. As
mentioned above, patients with VP typically have enlarged cerebral
ventricles, which are also a symptom of NPH. Impairment of gait is also
clinical comparable in VP and NPH. Furthermore, WMLs observed in
Binswanger disease are remarkably similar to those observed in NPH.
J. Komplikasi
K. Prognosis
DAFTAR PUSTAKA
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