[Disturbances of gait and postural stability in chronic cerebral ischemia]

Disturbances of gait and postural stability are characteristic of the chronic progressive vascular lesion of the brain observed in moderate to severe stages of cerebrovascular disease. Disconnections between the prefrontal cortex, basal ganglia and cerebellum due to the damage of the white matter (vascular leukoencephalopathy) underlie disturbances of gait and postural stability (shorter stride length, wider gait). There are difficulties in starting with possible stoppings during the walking, waiting in front of small barriers as well as difficulties in concentration (e.g., talk during walking worsen the gait). In contrast to Parkinson's disease, associated movements of hands are observed. The severity of gait disturbances is usually correlated with the severity of vascular cognitive impairment unified by the common underlying substrate - the dysfunction of the frontal brain lobes. Approaches to treatment of patients with vascular movement disorders are discussed.