Misfolding and abnormal aggregation of the neuronal protein α-synuclein has been implicated in the pathogenesis of Parkinson’s disease and related neurological disorders, such as dementia with Lewy bodies. α-synuclein is a conventional cytosolic protein and is thought to exert its pathogenic function exclusively in the neuronal cytoplasm in a cell-autonomous manner. However, the current model is being challenged by a series of new observations that demonstrate the presence of α-synuclein and its aggregated forms in the extracellular fluid both in vivo and in vitro. Extracellular α-synuclein appears to be delivered by unconventional exocytosis of intravesicular α-synuclein, although the exact mechanism has not been characterized. Compared to the cytosolic α-synuclein, intravesicular α-synuclein is prone to aggregation and the potential source of extracellular aggregates. A number of tissue culture studies suggest that exposure to extracellular α-synuclein aggregates induces microglial activation, release of pro-inflammatory cytokines from astrocytes, and neurotoxicity. Thus, exocytosis of α-synuclein may be an important mechanism for amplifying and spreading degenerative changes from a small group of cells to its surrounding tissues, and it potentially provides therapeutic targets for halting the progression of the disease.