INTRODUCTION: Neuroimaging studies of elderly individuals reveal alterations in the white matter that are incompatible with the patient's parkinsonism, mistakenly classified as vascular parkinsonism (VP). METHOD: This study was conducted on a population composed of 20 patients with Parkinson's disease (PD) whose neuroimaging exams revealed vascular alterations in the white matter and seven patients with VP in order to compare diagnostic criteria. RESULTS: Age at disease onset of patients with PD was 55±12 years and patients with VP it was 62±13 years. Twelve patients with PD and five patients with VP presented arterial hypertension; three patients with VP and two patients with PD presented gait impairment; all patients with VP presented rigidity and bradykinesia, six of them presented resting tremor; 19 patients with PD presented tremor and 19 of them presented rigidity, while 17 presented bradykinesia. When the symptoms and evolution of both diseases were compared, the vascular alterations in the white matter were considered unspecific. CONCLUSION: Since clinical symptoms are unspecific, a differential diagnosis requires neuroimaging, good response to levodopa and clinical evolution. © 2006 Associação Arquivos de Neuro-Psiquiatria.6403:00:00 Critchley, M., Arteriosclerotic parkinsonism (1929) Brain, 52, pp. 23-83Winikates, J., Jankovic, J., Clinical correlates of vascular parkinsonism (1999) Arch Neurol, 56, pp. 98-102Demirkiran, M., Bozdemir, H., Sarica, Y., Vascular parkinsonism: A distinct, heterogeneous clinical entity (2001) Acta Neurol Scand, 104, pp. 63-67Thanvi, B., Lo, N., Robinson, T., Vascular parkinsonism: An important cause of parkinsonism in older people (2005) Age Ageing, 34, pp. 114-119Zijlmans, J.C.M., Thijssen, H.O.M., Vogels, O.J.M., MRI in patients with suspected vascular parkinsonism (1995) Neurology, 45, pp. 2183-2188Bennet, D.A., Wilson, R.S., Gilley, D.W., Fox, J.H., Clinical diagnosis of Binswanger disease (1990) J Neurol Neurosurg Psychiatry, 53, pp. 961-965Hurtig, H.I., Vascular parkinsonism (1993) Parkinsonian Syndromes, pp. 81-83. , Stern MB, Koller WC (eds). New York: Marcel DekkerBaldereschi, M., Di Carlo, A., Rocca, W.A., Parkinson's disease and parkinsonism in a longitudinal study: Two-fold higher incidence in men (2000) Neurology, 55, pp. 1358-1363Foltynie, T., Barker, R., Brayne, C., Vascular parkinsonism: A review of the precision and frequency of diagnosis (2002) Neuroepidemiology, 21, pp. 1-7Benito-Leon, J., Bernejo-Pareja, F., Moralez-Gonzalez, J.M., Incidence of Parkinson's disease and parkinsonism in three elderly populations of central Spain (2004) Neurology, 62, pp. 734-741Bower, J.H., Dickson, D.W., Taylor, L., Maraganore, D.M., Rocca, W.A., Clinical correlates of the pathology underlyng parkinsonism: A population perpective (2002) Mov Disord, 17, pp. 910-916Zijlmans, J.C.M., Daniel, Se., Hughes, A.J., Révész, T., Lees, A.J., Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis (2004) Mov Disord, 19, pp. 630-640Fazekas, F., Niederkorn, K., Schmidt, R., White matter signal abnormalities in normal individuals: Correlation with carotid ultrasound, cerebral blood flow measurements, and cerebrovascular disease risk factors (1988) Stroke, 19, pp. 1285-1288Larsen, J.P., Dupont, E., Tandberg, E., Clinical diagnosis of Parkinson's disease: Proposal of diagnostic subgroups classified at different levels of confidence (1994) Acta Neurol Scand, 89, pp. 242-251Elbaz, A., Bower, J.H., Maraganore, D.M., Risk tables for parkinsonism and Parkinson's disease (2002) J Clin Epidemiol, 55, pp. 25-31(1994) Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, , American Psychiatric Association Washington, DC: American Psychiatric AssociationSibon, I., Fenelon, G., Quinn, N.P., Tison, F., Vascular parkinsonism (2004) J Neurol, 251, pp. 513-524Zijlmans, J.C.M., Katzenschlager, R., Daniel, S.E., Lees, A.J.L., The L-dopa response in vascular parkinsonism (2004) J Neurol Neurosurg Psychiatry, 75, pp. 545-547Piccini, P., Pavese, N., Canapichi, R., White matter hiperintensities in Parkinson's disease (1995) Arch Neurol, 52, pp. 191-194Murrow, R.W., Schweiger, G.D., Kepes, J.J., Koller, W.C., Parkinsonism due to basal lacunar state: A clinicopathological correlation (1990) Neurology, 40, pp. 897-900