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Vascular parkinsonism — DGM MCQ

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HardMovement disordersVascular parkinsonismDGM

An 78-year-old man has bilateral leg stiffness, early falls and urinary urgency. He has a symmetrical lower-body parkinsonian gait and MRI shows extensive small-vessel disease. Levodopa has produced little benefit. What is the most likely diagnosis?

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Correct answer: B — Vascular parkinsonism

Lower-body predominant, symmetrical parkinsonism with vascular imaging changes and poor levodopa response suggests vascular parkinsonism. Idiopathic Parkinson's disease is usually asymmetric at onset and more levodopa responsive. Vascular risk assessment remains important in management.

Reference: NICE NG71; NICE NG127