The Role of Imaging in the Diagnosis of Vascular Parkinsonism

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, Critchley 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 Critchley’s ideas and what is now commonly known as vascular parkinsonism (VP). 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. 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.