To evaluate in detail the clinical features in a large series of pathologically confirmed cases of vascular Parkinsonism (VP).In the absence of widely accepted diagnostic criteria for VP pathological confirmation of diagnosis is necessary to ensure diagnostic reliability, and has only been reported in a few small series.The archival records of the Queen Square Brain Bank (QSBB) have been used to identify cases of Parkinsonism where cerebrovascular disease was the only pathological finding. Clinical notes were scrutinised and milestones of disease progression were compared with other atypical Parkinsonian syndromes from previous QSBB studies.Twenty-eight cases were included. Mean age of onset and disease duration were 70.6 (SD卤 6.42) and 10.5 (SD卤 66.1) years respectively. Bradykinesia was present in all cases, rigidity in 96%, falls in 76%, pyramidal signs in 54%, urinary incontinence in 50% and dementia in 39%.Visual hallucinations in 0%. Two-thirds had an insidious onset and a relentless rather than stepwise progression of disability. When compared with other Parkinsonian syndromes, VP had an older age of onset.In comparison with other Parkinsonian syndromes the patients were older and had an extremely low frequency of visual hallucinations compared with Parkinson's disease.

Movement disorders can occur as primary (idiopathic) or genetic disease, as a manifestation of an underlying neurodegenerative disorder, or secondary to a wide range of neurological or systemic diseases. Cerebrovascular diseases represent up to 22% of secondary movement disorders, and involuntary movements develop after 1-4% of strokes. Post-stroke movement disorders can manifest in parkinsonism or a wide range of hyperkinetic movement disorders including chorea, ballism, athetosis, dystonia, tremor, myoclonus, stereotypies, and akathisia. Some of these disorders occur immediately after acute stroke, whereas others can develop later, and yet others represent delayed-onset progressive movement disorders. These movement disorders have been encountered in patients with ischaemic and haemorrhagic strokes, subarachnoid haemorrhage, cerebrovascular malformations, and dural arteriovenous fistula affecting the basal ganglia, their connections, or both.

61Vascular Parkinsonism (VP) occurs with lacunar state or white matter micro-angiopathy.61Vascular Parkinsonism is associated with white matter lesions (WML).61No associations between WML score and age, or CVD risk factors in VP61The severity of WML is correlated with motor and non-motor manifestations in VP.

Progressive ambulatory impairment and abnormal white matter (WM) signal on neuroimaging come together under the diagnostic umbrella of vascular parkinsonism (VaP). A critical appraisal of the literature, however, suggests that (1) no abnormal structural imaging pattern is specific to VaP; (2) there is poor correlation between brain MRI hyperintensities and microangiopathic brain disease and parkinsonism from available clinicopathologic data; (3) pure parkinsonism from vascular injury ("definite" vascular parkinsonism) consistently results from ischemic or hemorrhagic strokes involving the SN and/or nigrostriatal pathway, but sparing the striatum itself, the cortex, and the intervening WM; and (4) many cases reported as VaP may represent pseudovascular parkinsonism (e.g., Parkinson's disease or another neurodegenerative parkinsonism, such as PSP with nonspecific neuroimaging signal abnormalities), vascular pseudoparkinsonism (e.g., akinetic mutism resulting from bilateral mesial frontal strokes or apathetic depression from bilateral striatal lacunar strokes), or pseudovascular pseudoparkinsonism (e.g., higher-level gait disorders, including normal-pressure hydrocephalus with transependimal exudate). These syndromic designations are preferable over VaP until pathology or validated biomarkers confirm the underlying nature and relevance of the leukoaraiosis. 2015 International Parkinson and Movement Disorder Society.

Postural stability analysis has shown that postural control is impaired in untreated idiopathic Parkinson's disease (IPD), even in the early stages of the disease. Vascular Parkinson's disease (VPD) lacks consensus clinical criteria or diagnostic tests. Moreover, the levodopa effect on postural balance remains undefined for IPD and even less so for VPD.To characterize postural stability, using kinematic analysis with wearable inertial measurement units, in IPD and VPD patients without clinical PI, and to subsequently analyze the response to levodopa.Ten patients with akinetic-rigid IPD and five patients with VPD were included. Clinical and postural stability kinematic analysis was performed before and after levodopa challenge, on different standing tasks: normal stance (NS), Romberg eyes open (REO) and Romberg eyes closed.In the "off state", VPD patients had higher mean distances and higher maximal distance of postural sway on NS and REO tasks, respectively. VPD patients maintained a higher range of anterior-posterior (AP) postural sway after levodopa. In the absence of PI and non-significant differences in UPDRS-III, a higher mPIGD score in the VPD patients was mainly due to gait disturbance. Gait disturbance, and not UPDRS-III, influenced the degree of postural sway response to levodopa for VPD patients.Quantitative postural sway evaluation is useful in the investigation of Parkinsonian syndromes. VPD patients have higher AP postural sway that is correlated with their gait disturbance burden and also not responsive to levodopa. These observations corroborate the interconnection of postural control and locomotor networks.

目的：探讨血管性帕金森综合征（VP）的临床特点及治疗。方法：对35例VP患者（VP组）和42例帕金森病（PD）患者（PD组）的临床资料进行比较分析。结果：VP组平均发病年龄晚于PD组，多合并有脑血管病危险因素，临床表现以步态障碍最为突出，头颅MRI主要表现以基底核区及皮质下白质腔隙性脑梗死为主，左旋多巴等药物对帕金森样症状的治疗有一定的改善作用。结论：VP的诊断应结合病史、临床表现和影像学特征进行综合分析。

Vascular parkinsonism (VP) remains a loose constellation of various clinical features. We systematically reviewed studies comparing clinical, neuroimaging and other investigations that might distinguish VP from idiopathic Parkinson's disease (PD). Medline, Embase, Cinahl (R), and PsycINFO were searched by querying appropriate key words. Reports were included if the study population contained comparative findings between patients with VP and PD. Twenty-five articles fulfilled the selection criteria. Patients with VP were older, with a shorter duration of illness, presented with symmetrical gait difficulties, were less responsive to levodopa, and were more prone to postural instability, falls, and dementia. Pyramidal signs, pseudobulbar palsy, and incontinence were more common in VP. Tremor was not a main feature of VP. Structural neuroimaging was more likely to be abnormal in VP (90-100% of cases) than in PD (12-43% of cases), but there was no specific abnormal structural imaging pattern for VP. Two studies of presynaptic striatal dopamine transporters (using single photon emission computed tomography) showed a significant reduction in striatal uptake ratios in PD but not in VP, whereas another study found that only the mean asymmetry index was significantly lower in VP. Various other investigations, including alternative imaging techniques, electrophysiological, and neuropsychological studies, are reported, but the diverse diagnostic criteria used makes it difficult to reach any firm conclusions. The development of accepted international diagnostic criteria for VP is urgently needed to facilitate further studies.

目的探讨灯盏细辛对早期血管性帕金森综合征的疗效。方法选用确诊的血管性帕金森综合征患者 80例,随机分为观察组和对照组各40例,观察组予以灯盏细辛注射液静脉滴注;对照组予以川芎嗪冻干粉静脉滴注,疗程均为14 d。观察两组患者治疗效果,治疗前后血液流变学的变化,UPDRS评分变化和Hoehn-Yahr评分变化。结果两组治疗后改良UPDRS评分均较治疗前 下降,差异均有统计学意义（P〈0.05）,而观察组明显下降,差异有统计学意义（P〈0.05）,观察组疗效优于对照组（P〈0.05）。结论灯盏细辛 注射液治疗早期血管性帕金森综合征效果明确。

Aim Establishing model of cerebral ischemia-reperfusion injury and intervening with Danhong injection,then observing morphological changes of cerebral cell in damaged area and Golgi,detecting Golgi Matrix Protein 130(GM130) expression,and exploring protective mechanism of Danhong injection on cerebral ischemia-reperfusion injury in rats.Methods 72 healthy adult SD rats were randomly divided into normal controlled group(6),sham operation group(6),ischemia-reperfusion group(30),and Danhong intervention group(30).According to the reperfusion time after ischemia 2 h,sham operation group and ischemia-reperfusion group were respectively divided into 6 h,24 h,48 h,72 h,and 7 days five subgroups,there were 6 rats in each subgroup.After the success of cerebral ischemia-reperfusion model,the rats in Danhong intervention group were interved with Danhong injection(8ml/kg,QD) by intraperitoneal injection from the recovery of reperfusion until they were executed;At the same time,the rats in ischemia-reperfusion group were treated with the same dose of normal saline by intraperitoneal injection.Results Morphology showed cortical neuronal survival number were significantly increased in Danhong intervention 7 d group compared with the other groups,and the damage degree was the lightest;In ischemia-reperfusion injury 7 d group,Golgi morphology took significantly impaired change,lack of network structure,lightly staining,granules decreasing or disappearing,and even some broken,but in Danhong intervention 7 d group,Golgi morphology kept normal.GM130 expression decreased with the prolongation of ischemia-reperfusion time,increased with the prolongation of Danhong injection intervention time.GM130 expression of Danhong intervention 7 d group was the highest compared with the other groups(P0.05).Conclusion Danhong injection may maintain the Golgi stability through the up-regulation of GM130 expression,and thus play a neuroprotective role.