Abstract
A 76-year-old woman presented with rest tremor in the right arm, global bradykinesia, rigidity in both arms and neck, and parkinsonian gait with poor response to levodopa. Neuroimaging studies revealed enhanced perivascular spaces in left striatum (Figures 1 and 2). Although commonly considered nonpathologic, when they are numerous or localized at the striatum or midbrain, they may have a role in the development of parkinsonism.1 Given their size, in this case, they might act as direct structural damage to dopaminergic terminals. Whether they could trigger neurodegeneration or might act in an additive fashion lowering the threshold for neurodegeneration to induce PD remains unclear.
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