Vascular parkinsonism: a case series of 17 patients / Parkinsonismo vascular: uma serie de casos de 17 pacientes

Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP). Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%), lower limb parkinsonism with freezing of gait and falls (82.3%), and pyramidal signs (76.4%). The mean Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1%) patients had freezing of gait and executive dysfunction. Twelve (70.5%) patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response. .

Objetivo Relatar os achados clínicos e de neuroimagem em parkinsonismo vascular (PV). Métodos Foram avaliados 17 pacientes com PV do ponto de vista motor, cognitivo e de neuroimagem através de testes e escalas padronizados. Resultados Dos 17 pacientes, 10 (58,5%) eram homens; a média de idade média foi 75,8±10,1 anos. Todos os pacientes eram hipertensos; a média de idade do início do parkinsonismo foi 72,2±10,0 anos. Achados clínicos mais frequentes: incontinência urinária (88,2%); parkinsonismo de membros inferiores com bloqueio de marcha e quedas (82,3%); sinais piramidais (76,4%). A média dos escores UPDRS e Hoehn-Yahr foram, respectivamente, 72,5±21,6 e 3,3±0,9 pontos. Dezesseis pacientes (94,1%) apresentaram bloqueio de marcha e disfunção executiva. Doze pacientes (70,5%) preencheram critérios para demência vascular provável. A dose média de levodopa foi 530,9 mg/dia e os pacientes tiveram uma baixa resposta à droga, tendo havido redução de apenas 6,9 pontos em média no escore UPDRS após o teste “practically-defined off”. Conclusão O perfil de PV encontrado neste estudo foi caracterizado por: envolvimento predominante de membros inferiores, com bloqueio de marcha e quedas; sinais piramidais; disfunção executiva; demência vascular concomitante e resposta pobre à levodopa. .

Hemiparkinsonism-hemiatrophy syndrome

The syndrome of hemiparkinsonism-hemiatrophy is an uncommon form of secondary Parkinsonism that presents with unilateral body Parkinsonism plus variable atrophy on the same side. Diagnosis of this syndrome needs a complete past medical history taking, as well as assessment of the familial history, clinical examination and complete paraclinical tests. The response to medical therapy has been variable in various researches. This case showed a good response to the addition of a dopamine agonist to levodopa therapy

Movement disorders caused by brain tumours.

Movement disorders are uncommon presenting features of brain tumours. Early recognition of such lesions is important to arrest further deficit. We treated seven patients with movement disorders secondary to brain tumours over a period of seven years. Only two of these were intrinsic thalamic tumours (astrocytomas) while the rest were extrinsic tumours. The intrinsic tumours were accompanied by hemichorea. Among the extrinsic tumours, there was one pituitary macroadenoma with hemiballismus and four meningiomas with parkinsonism. Symptoms were unilateral in all patients except one with anterior third falcine meningioma who had bilateral rest tremors. There was relief in movement disorders observed after surgery. Imaging by computed tomography or magnetic resonance imaging is mandatory in the evaluation of movement disorders, especially if the presentation is atypical, unilateral and/or accompanied by long tract signs.

Etiology of parkinsonism in a Brazilian movement disorders clinic

Objective: The aim of the present study is to investigate whether there are geographic differences in the etiology of parkinsonism (PA). Background: 72 percent of patients with PA evaluated at movement disorders clinics in the Northern Hemisphere are diagnosed with Parkinson's disease (PD). Data regarding other regions are not available. Methods: We reviewed the charts of all patients with PA seen at the Federal University of Minas Gerais Movement Disorders Clinic from July 1993 through October 1995. PA was diagnosed by the presence of at least two of the following: rest tremor, bradykinesia, rigidity, and postural instability. The different etiologies were diagnosed based on standard clinical criteria Results: During the period of the study, PA was recognized in 338 subjects. The following clinical diagnoses were made: PD (68.9 percent), drug-induced PA (DIP) (13,3 percent), vascular PA (4.7 percent), progressive supranuclear palsy (PSP) (2 percent), multiple system atrophy (MSA) (1.8 percent), others (9.7 percent). Cinnarizine, haloperidol and flunarizine were the commonest drugs related to DIP. Conclusions: Similarly to other studies, PD accounts for about 70 percent of PA patients. However, there are differences between our results and previous series. DIP is much more common in the present series. This may be accounted for a more liberal use of antidopaminergic drugs in our environment, especially Calcium channel blockers. The lower frequency of MSA and PSP in our study may reflect a short follow-up, since many patients initially diagnosed with PD later are found to have Parkinson-plus syndromes.

Tratamento da doença de Parkinson / Treatment of Parkinson disease

Doença de Parkinson (DP) é a causa mais freqüente de parkinsonismo em nosso meio, responsável por 58 por cento dos casos. Devem-se excluir outras causas, como uso de drogas antidopaminérgicas (20 por cento dos casos). Levodopa é o agente mais importante para o tratamento de DP. Há controvérsia sobre quando se introduzir esta droga mas deve-se reservá-la para quando surgir substancial comprometimento funcional. Drogas acessárias säo anticolinérgicos, úteis para o tremor, amantadina, para bradicinesia e rigidez; e agonistas dopaminérgicos que ajudam no manuseio de complicaçöes da levodopa. A selegelina tem discreta açäo sintomática e possível açäo neuroprotetora. O tratamento de DP pode ser complicado por falha primária, falha secundária e problemas do uso da levodopa. A falha primária pode ser causada por uso de agentes antidopaminérgicos, presença de tremor de repouso severo ou erro diagnóstico. A causa mais comum de falha secundária é progressäo da DP. As principais complicaçöes do uso da levodopa säo flutuaçöes e discinesias. Outros problemas comuns säo disautonomia, depressäo, psicose e demência. Fenomenologia e manuseio destas complicaçöes säo discutidos. Perspectivias futuras incluem cirurgias para reversäo de patologia

Actualización por temas: depresión en la esquizofrenia / Themes of interest: Depression in schizophrenia

El síndrome que acompaña generalmente a la esquizofrenia es la depresión. Estos síntomas depresivos han sido reconocidos y descritos desde la época de Kreplin y Bleuler, pero su significado sigue siendo controvertido para el pronóstico de esta enfermedad. Los síntomas que contribuyen al diagnóstico de un episodio depresivo mayor, no son necesariamente exclusivos de la depresión y se pueden sobreponer a los síntomas del síndrome negativo, de la aquinesia o a los síntomas prodrómicos de una recaída psicótica. Pese a que durante los últimos años se le ha dado más atención al estudio y manejo de la depresión en la esquizofrenia, aún es incierto el diagnóstico y tratamiento de esta entidad nosológica

Signos extrapiramidales en pacientes con multinfartos encefálicos profundos (Parkinsonismo vascular) / Extrapyramidal findings in patiens with deep cerebral multiple infarcts (vascular parkinsonism)

Fueron seleccionados prospectivamente 44 pacientes con multinfartos cerebrales profundos. Estos se dividieron en dos grupos, uno compuesto por los pacientes con signos extrapiramidales (n=29), y el otro sin ellos (grupo control)(n=15). El 65,9 por ciento de los casos seleccionados tuvieron signos extrapiramidales de grado leve a moderado, constituyendo un síndrome hipocinético rígido sin temblor. Todos los pacientes de ambos grupos tuvieron otros defectos neurológicos, su distribución no fue diferente entre los grupos comparados. La localización topográfica de los infartos, la presencia de leukoaraiosis y la dilatación de los ventrículos fue semejante en ambos grupos. El origen de los signos extrapiramidales es explicado por una génesis fisiopatológica funcional, más que estructural, secundaria a una hipoxia persistente relacionada con el daño vascular multifocal

Development of parkinsonism after transient ischemic attacks

Para tratar de correlacionar la influencia de los trastornos cerebrovasculares en el desarrollo de cuadros parkinsonianos, 115 pacientes con ataques isquémicos transitorios cuyas edades oscilan entre 32 y 84 años fueron evaluados durante un año. Los pacientes recibieron tratamiento con antiagregantes plaquetarios. En ningún caso fueron tratados con neurolépticos, antagonistas del calcio y otras drogas que pudieran causar parkinsonismo. Durante el estudio, 8 pacientes desarrollaron un cuadro parkinsoniano que fue bilateral en 7 de ellos. El único caso asimétrico fue también el único que respondió al tratamiento con L dopa. Al comparar la incidencia registrada con la esperada observamos un valor significativamente mayor en nuestra serie. Estos hallazgos sugieren que los trastornos cerebrovasculares son factores que contribuyen en el desarrollo del parkinsonismo en el anciano