Although the concept of vascular parkinsonism, proposed by Critchley in 1929, was almost abandoned for many years, it has once more come to the fore. The prevalence and incidence of vascular parkinsonism is variable in different series. Diagnosis of vascular parkinsonism is usually suggested by acute onset or other signs of cerebrovascular disease, but needs to be confirmed by imaging studies (72). This is the form of parkinsonism that frequently can be diagnosed by CT, without requiring MRI to demonstrate the lesions.
The lesions usually are lacunar or small infarcts in the basal ganglia, mostly in the putamina (Fig. 6). A single lesion in one putamen may sometimes justify the contralateral parkinsonism. Parkinsonism may also be associated with multiple infarcts or white matter lesions in the subcortical arteriosclerotic encephalopathy (72), which is more accurately shown by MRI. In this disease, precise clinico-radiological correlations are difficult to obtain. Parkinsonian symptoms and signs may be associated with lesions in the basal ganglia or in the white matter of the cerebral hemispheres probably because of involvement of the striato-thalamic connections with the frontal cortex.
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