Diagnóstico del parkinsonismo vascular: correlación de la clínica con la neuroimagen y la utilidad de la SPECT con 123I-ioflupano
PÉREZ M, PÉREZ ASENSIO R, BURGUERA J
Neurología 2008;23(9): 566-574
Resumen del Autor:
Introduction. The concept of vascular parkinsonism (VP) has evolved since it was introduced by Critchley. The relationships between the clinical manifestations and neuroimagining of patients with VP to determine the utility of SPECT in its diagnosis have been established. Material and methods. Retrospective study of patients with suspicion of VP according to Ziljmans 2004 criteria. Results. A total of 22 patients were included. The most frequent risk factor was AHT. The most frequent manifestations were: bradykinesis, followed by gait disorder. Response to L-dopa was related with symptoms in lower limbs (p=0.014). The most frequent alterations on the magnetic resonance imaging were: atrophy with ventricular dilation followed by white matter lesions. The Hachinski scale was related with acute onset (p=0.022) and territorial infarction (p=0.039), and the Winikates with subcortical- paraventricular white matter lesions (p=0.036), and both with gender (male) (p=0.031), and stroke background (p=0.022). Alteration in gait was associated with paraventricular white matter lesions (p = 0.043), and other manifestations with lesions in the medulla (p=0,020). Tremor was associated with bilateral involvement of putamens in SPECT (p=0.039), strategic lesion with putamen involvement (p = 0.028) and lesions of periventricular white matter lesions with SPECT type 1 and 2 (p=0.045). There were no significant relationships of the SPECT with response to L-dopa or with the scales. Discussion. The different relationships between symptoms, scales and neuroimagin show the complexity of the subject and the need to use all of them in the diagnosis of VP. Key words: 123I-FP-CIT. Arteriosclerotic parkinsonism. Vascular parkinsonism. Parkinsonism of lower limbs. Gait disorder in the elderly. Ioflupane SPECT. Neurología 2008;23(9):566-574
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