Kata Kunci

Abstrak

Introduction: Vascular parkinsonism has a prevalence of 4.4% to 12% among parkinsonism cases. Until now, there are no specific diagnostic criteria to establish the diagnosis of vascular parkinsonism, making it often misdiagnosed as idiopathic parkinsonism. Case Report: An 82-year-old male presented with gait disorder 3 years ago, appearing stiff with small steps. The patient became slower, drooled frequently, and had difficulty swallowing food. He was diagnosed with Parkinson's disease and given levodopa/benserazide. However, the disease progressed, leading to an increased dosage. Over the past 2 years, the patient became forgetful and more irritable. He had a history of ischemic stroke 3 years ago with no sequelae, as well as a history of hypertension and gout arthritis (GA). The patient was compos mentis without signs of focal deficit or lateralization, but there was cogwheel-type rigidity in all extremities without any tremor. The MoCA-Ina (Montreal Cognitive Assessment Indonesian Version) test score was 21. A head CT (Computer Tomography) scan revealed chronic lacunar infarct with brain atrophy and small vessel ischemic changes. The patient was then diagnosed with vascular parkinsonism and treated with levodopa, acetosal, candesartan, and referred to the medical rehabilitation department. Discussion: Based on the criteria of Zijlmans et al., and Winikates and Jankovic, the patient is included in vascular parkinsonism, marked by the presence of bradykinesia, rigidity, and postural instability, which indicates parkinsonism accompanied by 3 vascular scores. Conclusion: The diagnosis of vascular parkinsonism is very complex and challenging. Multidisciplinary management from neurologists and medical rehabilitation specialists must be applied to improve the quality of life, and reduce morbidity and mortality.