Cerebral Perfusion in Patients with Vascular Parkinsonism
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Background: The aim of this study was to document the regional cerebral blood flow (rCBF) abnormality in the Single Photon Emission Computed Tomography (SPECT) of the patients with vascular parkinsonism (VP). Methods: 99mTc-ECD SPECT was performed to measure the rCBF in the resting state. VP was defined as those who had parkinsonism (≥60 years) with vascular lesions within the basal ganglia and white matters on MRI, and were excluded if they had at least one of the following features: resting tremor, neuroleptic therapy, brain trauma, supranuclear gaze palsy, retrocollis, disproportionate antecollis, cerebellar signs at onset, fixed dystonic posture of the arm, action- or stimulus-sensitive myoclonus of the arm, alien hand syndrome, polyneuropathy, respiratory stridor, and orthostatic hypotension (>30 mmHg), or hydrocephalus on brain MRI. Cerebral perfusion was measured in six regions of interest (ROI) including the frontal, lateral prefrontal, inferior prefrontal, supplementary motor, parietotemporal and primary sensory motor area. Levo-dopa responsiveness in patients with VP was evaluated by UPDRS part III scores, a hand-arm movement, and a timed walking test. Results: All patients enrolled in this study presented with predominant gait impairment, relative sparing of the upper limbs and face, and poor levo-dopa responsivenss. A significant regional cerebral hypoperfusion in patients with VP was not demonstrated when compared with control groups. Conclusion: These results failed to find evidence supporting the hypothesis that VP, which is prone to more dominant involvement of the legs, might be related to frontal lobe dysfunction like frontal hypoperfusion. Our results may be suggestive of another possible mechanism of gait disturbance in VP. (Korean Journal of Stroke 2007;9:42-45)
Abstract
Background: The aim of this study was to document the regional cerebral blood flow (rCBF) abnormality in the Single Photon Emission Computed Tomography (SPECT) of the patients with vascular parkinsonism (VP). Methods: 99mTc-ECD SPECT was performed to measure the rCBF in the resting state. VP was defined as those who had parkinsonism (≥60 years) with vascular lesions within the basal ganglia and white matters on MRI, and were excluded if they had at least one of the following features: resting tremor, neuroleptic therapy, brain trauma, supranuclear gaze palsy, retrocollis, disproportionate antecollis, cerebellar signs at onset, fixed dystonic posture of the arm, action- or stimulus-sensitive myoclonus of the arm, alien hand syndrome, polyneuropathy, respiratory stridor, and orthostatic hypotension (>30 mmHg), or hydrocephalus on brain MRI. Cerebral perfusion was measured in six regions of interest (ROI) including the frontal, lateral prefrontal, inferior prefrontal, supplementary motor, parietotemporal and primary sensory motor area. Levo-dopa responsiveness in patients with VP was evaluated by UPDRS part III scores, a hand-arm movement, and a timed walking test. Results: All patients enrolled in this study presented with predominant gait impairment, relative sparing of the upper limbs and face, and poor levo-dopa responsivenss. A significant regional cerebral hypoperfusion in patients with VP was not demonstrated when compared with control groups. Conclusion: These results failed to find evidence supporting the hypothesis that VP, which is prone to more dominant involvement of the legs, might be related to frontal lobe dysfunction like frontal hypoperfusion. Our results may be suggestive of another possible mechanism of gait disturbance in VP. (Korean Journal of Stroke 2007;9:42-45)