A stroke doesn’t always look like a stroke. Sometimes, small strokes and other blood-vessel damage in the brain can affect pathways involved in movement, causing problems that look a lot like Parkinson’s disease. That’s vascular parkinsonism — a distinct condition with its own cause, course, and treatment approach.

It can be confusing to get a diagnosis that sounds so similar to Parkinson’s disease, especially when many of the day-to-day symptoms overlap. Understanding what sets vascular parkinsonism apart — from what causes it to what you can expect over time — can help you make sense of your diagnosis and work with your care team on a plan that fits your needs.

What Causes Vascular Parkinsonism?

Vascular parkinsonism is caused by problems with blood flow in the brain. These may include multiple small strokes, reduced blood flow that damages the brain’s white matter (tissue made mostly of nerve fibers that help different brain areas communicate), or, less often, a large blood vessel stroke.

Several risk factors for blood vessel disease can also raise the risk of vascular parkinsonism:

• Hypertension (high blood pressure)
• Dyslipidemia (unhealthy levels of either cholesterol or triglycerides)
• Heart disease
• Diabetes
• Sleep apnea
• Smoking

What Are the Signs and Symptoms of Vascular Parkinsonism?

Vascular parkinsonism can have signs and symptoms that differ from those of Parkinson’s disease and the other parkinsonian syndromes, such as progressive supranuclear palsy, dementia with Lewy bodies, and multiple system atrophy.

Symptoms of vascular parkinsonism may come on suddenly, such as after a stroke. In other cases, they may develop gradually over months or years as blood vessel damage builds up in the brain. Symptoms may include:

• Slow, wide-based walking with short steps and hesitations
• Postural instability (difficulty in keeping your balance while upright)
• Muscle tightness or spasticity, particularly in the legs
• Muscle stiffness or rigidity, especially in the legs
• Pseudobulbar palsy, which can cause difficulty speaking, trouble swallowing, tongue and face weakness, and difficulty controlling laughter or crying
• Incontinence (difficulty controlling the bladder or bowels)
• Memory loss, difficulty thinking clearly, or other cognitive impairments

How Is Vascular Parkinsonism Diagnosed?

A neurologist, often one who specializes in movement disorders, typically diagnoses vascular parkinsonism. During the exam, they’ll check for signs of the condition and ask about symptoms you’re experiencing.

If the exam suggests vascular parkinsonism, your neurologist may order brain imaging, such as an MRI or CT scan. In 90 percent to 100 percent of vascular parkinsonism cases, these scans show abnormalities, often including small strokes or changes in the brain’s white matter.

However, no single imaging pattern can confirm vascular parkinsonism by itself. People without vascular parkinsonism can have similar changes on brain scans, so your care team will consider your imaging results along with your symptoms and medical history before making a diagnosis.

How Does Vascular Parkinsonism Differ From Parkinson’s Disease?

Parkinson’s disease and vascular parkinsonism have different underlying causes. Vascular parkinsonism is associated with blood vessel disease in the brain, including strokes and other problems that affect blood flow, whereas Parkinson’s disease is a progressive, neurodegenerative condition involving the gradual loss of certain brain cells.

“Vascular Parkinson’s is not Parkinson’s,” one MyParkinsonsTeam member wrote. “It only mimics and shows symptoms that are much like Parkinson’s. Basically, it is caused by small strokes.”

How Is Vascular Parkinsonism Treated?

Your healthcare team will work with you to create a treatment plan for vascular parkinsonism. The plan may include strategies to reduce the risk of future strokes, physical therapy, exercise, and medication.

Stroke Prevention

Because vascular parkinsonism is linked to blood vessel disease in the brain, reducing the risk of future strokes is an important part of treatment. This may include managing high blood pressure, unhealthy cholesterol or triglyceride levels, and diabetes, as well as quitting smoking.

Physical Therapy and Exercise

Physical therapy can help people with vascular parkinsonism improve balance and lower their risk of falling. Therapy may include balance training and learning to use mobility aids, such as canes and walkers, to improve safety and steadiness. “I can’t walk very well owing to my vascular parkinsonism, so I use my mobility scooter,” one MyParkinsonsTeam member said.

Regular exercise can also help reduce the risk of another stroke. Aerobic exercise may help manage some stroke risk factors, including high blood pressure and unhealthy cholesterol levels.

Medication

Parkinson’s disease medications may provide limited benefit for many people with vascular parkinsonism. However, levodopa may improve symptoms such as slowness of movement and muscle stiffness in some people. Doctors may recommend a trial of levodopa to see whether it improves symptoms.

What Is the Outlook for Vascular Parkinsonism?

Vascular parkinsonism is a lifelong condition, but unlike Parkinson’s disease, it doesn’t necessarily get steadily worse over time.

Your outlook depends largely on your overall health and whether additional strokes or vascular damage occur. Symptoms may stay fairly stable for some people, while another stroke may cause new or worsening symptoms.

Managing risk factors such as high blood pressure, unhealthy cholesterol levels, and diabetes can help reduce your risk of future strokes. Regular medical care can help you and your healthcare team monitor these risk factors and adjust your treatment as needed.