Parkinsonism, small vessel disease, and white matter disease Is there a link?

Parkinsonian syndrome is primarily attributed to striato-nigral degeneration as idiopathic Parkinson disease (PD), although it can be caused by white matter (WM) disease as classically seen in vascular parkinsonism (VP). VP clinically manifests as predominant lower extremities involvement and gait impairment with poor response to levodopa and, radiologically, as WM hyperintensities (WMH) that disrupt the striato-nigral pathways. However, brain MRI vascular lesions correlate poorly with clinical manifestations and pathology findings.(1)