GAIT DISORDER AND PARKINSONIAN SIGNS IN PATIENTS WITH STROKE RELATED TO SMALL DEEP INFARCTS AND WHITE-MATTER LESIONS

Vascular parkinsonism is thought to be a distinct parkinsonian syndrom e associated with small deep infarcts and white matter lesions (WMLs). We studied the prevalence of parkinsonian features (bradykinesia, rig idity, tremor, and gait disorder) in relation to small deep or territo rial infarcts and WMLs on computed tomography (CT) in 62 lacunar and 4 1 territorial stroke patients, at 3.0 (median) years of follow up. One or more parkinsonian signs were found in 36% of these patients; 11% c linically had parkinsonism. Parkinsonian signs were found more frequen tly in lacunar than in territorial stroke patients: bradykinesia in 45 % and 7%, rigidity in 13% and 7%, tremor in 6% and 7%, and gait disord er in 16% and 7%, respectively. Patients with WMLs at study entry (n = 16) were compared with those without WMLs (n = 87): 56% and 25% had b radykinesia, 25% and 8% rigidity, 25% and 3% tremor, and 38% and 8% ga it disorder, respectively. Regression analysis with adjusted odds rati os ([a]OR) showed that WMLs at study entry were associated with bradyk inesia ([a]OR 8.0, 95% confidence interval [CI] 1.6-41.6), gait disord er ([a]OR 7.1, 95% CI 1.5-33.7), and tremor ([a]OR 7.0, 95% CI 1.2-40. 3). Bradykinesia was associated with lacunar stroke at study entry ([a ]OR 11.5, 95% CI 2.4-54.9). Thus, one third of our stroke patients had one or more parkinsonian signs, and 10% clinically had a parkinsonian syndrome that differed from Lewy body parkinsonism: infrequent restin g tremor, but frequent gait disorder. Parkinsonian signs were associat ed with WMLs and lacunar stroke. Therefore, this study favors a distin ct vascular parkinsonian syndrome.