DOPPLER SONOGRAPHY CHARACTERISTICS OF VERTEBROBASILAR CIRCULATION IN PATIENTS WITH PARKINSON ’ S DISEASE

Th e objective of the study was to analyze the doppler sonography fi ndings of vertebrobasilar circulation (VB) in patients with Parkinson’s disease.  patients were analyzed ( men’s and  women) with Parkinson’s disease, average age was , years (SD=,), treated at the Clinic for Neurology in Tuzla. Device for doppler sonography was Multidop x . Doppler sonography fi ndings of VB circulation were analyzed in order to computerized tomography (CT) fi ndings of the brain (with or without ischemic lacunar lesions) and in order to presence of postural disturbances as one of dominant Parkinson’s disease symptoms during actual hospitalization. Our results suggest that vertebrobasilar insuffi ciency is more frequent in patients with Parkinson’s disease (no matter of type) and postural disturbances as a dominant symptom comparing to group of Parkinson’s disease patients without postural disturbances. Th ese results implicate the importance of doppler sonography fi ndings of vertebrobasilar circulation in patients with Parkinson’s disease and possibility of considering role of vertebrobasilar insuffi ciency in development of postural disturbances.


Introduction
Parkinson's disease is neurodegenerative disease leading to patients inability, which is primarily caused by cells loss containing dopamine in substantia nigra, decreasing dopamine concentration in striatum as well ().In USA more then million people have this disease and incidence is getting higher with extending human life ().Characteristics of this disease are tremor, rigor, posture disorder and bradicinesia, slowly and constantly deteriorating over the years (,).The objective of the study was to analyze doppler sonography findings of vertebrobasilar circulation (VB) in patients with Parkinson's disease.

Patients and Methods
Forty patients ( men's and  women) with Parkinson's disease were analyzed, average age of , years (SD=,), treated at the Clinic for neurology in Tuzla.Device for doppler sonography was Multidop x .Th e lower physiological values limits were: the average speed blood fl ow of  cm/s in basilar and cm/s in both vertebral arteries.VB circulation was analyzed both in order to computerized tomography (CT) fi ndings of the brain (with or without ischemic lacunar lesions) and presence of postural disturbances as one of dominant Parkinson's disease symptoms during actual hospitalization.For statistical evaluation it was used standard statistical parameters: mean value, percentage, χ² test.

Results
In this study postural disturbances as a dominant symptom was more frequent noticed in group of patients with Parkinson's disease associated with vascular lesions (/; ) in order to group with idiopatic Parkinson's disease (/; ) (Figure ).Associated postural disturbances and verified VB insufficiency is significantly higher (p=,) in first group (/, ) in order to second group (/; ) of patients (Figure ).
VB insufficiency, verified by doppler sonography, in patients with Parkinson's disease (no matter of type) and postural disturbances as a dominant symptom (n=), was presented in  patients () what was signifi cantly diff erent (p=,) in order to group of patients without postural disturbances (n=) where VB insuffi ciency was verifi ed in  patients () (Figure ).

Discussion
Postural disorder generate walking disturbance, reducing mobility and can provoke patients injuries.Th is is leading symptom in loss of functional independency and social isolation of patients ().In this study postural disturbances as a dominant symptom was more frequent in group of patients with Parkinson's disease associated with vascular lesions in order to group with idiopatic Parkinson's disease.Other authors reported that postural instability, "freezing" phenomenon, gait disturbance, pyramidal signs, and postural tremor were significantly more frequent in patients with Parkinson's disease associated with vascular lesions than in patients with idiopatic Parkinson's disease ().Verifi ed VB insuffi ciency associated with postural disturbances is signifi cantly more frequent in fi rst group as well.Vertebrobasilar insuffi ciency, verifi ed by doppler sonography, in patients with Parkinson's disease (no matter of type) and postural disturbances as a dominant symptom (n=), was presented in  of patients in order to group of patients without postural disturbances where VB insuffi ciency was verifi ed in  of patients.Diagnosis of Parkinson's disease is based on clinical signs, symptoms and responds to therapy which is goal reduction in degeneration of dopamine neurons, the main pathophysiolical disorder in Parkinson's disease ().Th ere is no specifi c diagnostic test for Parkinson's disease.Results of this study refer that in patients with dominant postural disturbances, beside usual tests (laboratory tests, CT of the brain or nuclear magnetic resonance) also it is necessary to evaluate a vertebrobasilar circulation.

Conclusion
Doppler sonography of vertebrobasilar circulation in Parkinson's disease patients might become important test and open possibility of vertebrobasilar insufi ciency impact on development of postural disturbances.