title: Higher level gait disorders in subcortical chronic vascular encephalopathy: a single photon emission computed tomography study.
abstract: BACKGROUND
  the so-called higher level gait disorders include several types of gait disorders in which there are no major modifications in strength, tone, sensitivity, coordination and balance. Brain activation sites related to walking have been investigated using SPECT in humans. The aim of the study was to investigate brain activation during walking in subjects with high-level gait disorders due to chronic subcortical vascular encephalopathy.
  
  
  METHODS
  twelve patients with a chronic vascular encephalopathy were enrolled in the study. Seven subjects had apraxic gait while in the other five the gait was normal. All patients had undergone a recent cerebral magnetic resonance that revealed diffused chronic ischemic lesions within the white matter.
  
  
  METHODS
  all 12 patients underwent a regional cerebral blood flow (rCBF) brain SPECT study with (99m)Tc-Bicisate on two separate days and under two different conditions: at rest (baseline) and while walking (functional).
  
  
  RESULTS
  the rCBF increase induced by the treadmill test (functional-baseline), bilaterally in the medial frontal gyrus and in the anterior lobes of the cerebellum, resulted significantly (P < 0.001) lower in patients with gait apraxia versus those without it.
  
  
  CONCLUSIONS
  this study of the brain with SPECT records the areas of perfusion deficit that appear in apraxic subjects when they walk, compared with the recordings obtained with the same investigation performed at rest.
authors.affiliation: Neurorehabilitation Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. m.carboncini@ao-pisa.toscana.it
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Carboncini
authors.forename: Duccio
authors.initials: D
authors.lastname: Volterrani
authors.forename: Luca
authors.initials: L
authors.lastname: Bonfiglio
authors.forename: Gabriele
authors.initials: G
authors.lastname: Barsotti
authors.forename: Mauro
authors.initials: M
authors.lastname: Della Porta
authors.forename: Giuliano
authors.initials: G
authors.lastname: Mariani
authors.forename: Bruno
authors.initials: B
authors.lastname: Rossi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001931:Brain Mapping / Q000379:methods*; D002531:Cerebellum / Q000098:blood supply*; D002560:Cerebrovascular Circulation; D003545:Cysteine / Q000031:analogs & derivatives; D015140:Dementia, Vascular / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply*; D020235:Gait Apraxia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D016138:Walking
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine