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Vascular parkinsonism — SCE Geriatric Medicine MCQ

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ModerateNeurologyVascular parkinsonismSCE Geriatric Medicine

An 83-year-old man with previous lacunar stroke and diabetes has recurrent falls and urinary urgency. Examination shows bradykinesia, lower-body rigidity, shuffling gait and pyramidal signs; tremor is absent. MRI brain shows extensive small-vessel disease and lacunes. What is the most likely diagnosis?

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Correct answer: A — Vascular parkinsonism

Lower-body predominant parkinsonism with pyramidal signs and extensive cerebrovascular disease suggests vascular parkinsonism. Idiopathic Parkinson disease more often begins asymmetrically with rest tremor and levodopa responsiveness, although overlap exists. NPH may mimic gait disorder but would usually show ventriculomegaly out of proportion to atrophy. The pearl is that gait-predominant parkinsonism in older adults often has vascular or mixed pathology.

Reference: NICE NG71; JRCPTB geriatric curriculum