Clinical features of vascular parkinsonism: a modern view on the problem (literature review and own observations)

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The aim of our research was to study modern ideas about the clinical course, diagnosis and differential diagnosis of vascular, post-stroke parkinsonism among the patients who suffered from the cerebral stroke during 10 years of the observation in Brovary. The resources PubMed (1990-2018) and UpToDate (2016) were used to write the review article. The vascular parkinsonism is a variant of secondary parkinsonism, caused by the ischemic or hemorrhagic lesions of the basal ganglia, the middle brain and/or their connections with the frontal lobes. The part of patients with the vascular parkinsonism (VP) makes up only 1.0-3.2% in the structure of all patients with parkinsonism [22, 37]. The vascular parkinsonism differs from Parkinson’s disease with more rapid disease progression and unfavorable course [3, 6, 9, 16, 22, 27, 37]. Taking into consideration the wide range of clinical manifestations, not clear criteria, the diagnosis of vascular parkinsonism is ambiguous, which makes relevant the problem of studying this pathology and modern concepts of diagnosis and therapy. Dopaminergic drugs are ineffective in most patients with vascular parkinsonism [26, 27, 28]. This article shows the analysis of the epidemiological parameters of cerebral strokes in Brovary, Kiev region. The total number of patients was 5818 (mean age 73.5 ± 10.2). Signs of vascular parkinsonism were detected in 73 patients (1.25%), including 44 (60%) women and 29 (39%) men. The lesions of subcortical structures were verified on CT and МRI. The dispensary group consisted of 312 patients with parkinsonism in 2016. The proportion of vascular parkinsonism was 23.3% of all patients with parkinsonism. Taking into consideration the progressive increase in stroke risk factors, the increase in stroke incidence among the population in Brovary (Kyiv region, Ukraine) has increased more than 4 times since 1991 (from 186 to 752 patients). The actual problem of the current time are cerebrovascular disease, strokes and their complications, which placed a heavy burden on the country’s society. Based on the aforementioned, further research would be required in this area, as well as the development of a new scientific concept regarding the prevention, early diagnosis and treatment of cerebral stroke, thus reducing disability and mortality, improving the quality of life of patients and their relatives. Keywords: vascular parkinsonism, clinical features, disease course, diagnostic criteria, differential diagnosis, risk factors.