The comparison of cerebral hemodynamic parameters between vascular parkinsonism and parkinson's disease patients using transcranial doppler ultrasound


Thesis Type: Expertise In Medicine

Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey

Approval Date: 2014

Student: DOĞA VURALLI

Supervisor: HATİCE AYŞE BORA

Abstract:

Cerebrovascular disease is an important cause of secondary parkinsonism and vascular parkinsonism consists of %3-12 of all parkinsonism cases. Parkinson's disease is a neurodegenerative disease caused by loss of dopaminergic neurons in nigrostriatal pathway. It is important to differentiate these two diseases. It is hard to differentiate progressive VP with an asymmetrical onset, from PD. New tools are needed to improve the accuracy of the diagnosis. Transcranial Doppler Ultrasound is an easy and reliable method to evaluate cerebral hemodynamics. In this study, peak systolic and mean blood flow velocities, resistivity and pulsatility indices of MCA, ACA, ICA, VA and BA were measured in 19 PD, 12 VP patients and 20 healthy volunteers. Vm was lower, RI and PI values were higher in all arteries in VP patients compared to the control group. Vm were lower, RI and PI values were higher in ACA, ICA and VA in VP patients when compared to PD patients. MCA, ACA, ICA and BA RI and PI values were higher and ICA, BA Vm were lower in PD group when compared with the control group. This might be due to degeneration of the subcortical neuronal systems and the sympathetic innervation of cerebral vessels and elevation of homocysteine due to levodopa treatment. In VP, Vm is low, PI and RI are high in both extracranial and intracranial arteries which demonstrate that VP is associated with decreased arterial elasticity, increased distal vascular resistance and decreased cerebral blood flow. A TCD study with a larger study population, in which a cut-off value for PI for each artery is determined, might help to differentiate VP from PD.