ABSTRACT
Vascular disease of the brain ranks among the top three causes of gait impairment in the older adult.1,2 In addition to the obviously spastic gait of someone that has had a stroke, cerebrovascular disease is an important cause of progressive gait impairment in older patients, many of whom have never had a typical stroke syndrome. Because the etiology and rehabilitation aspects of the spastic gait, with isometric weakness of the leg, are reviewed in Chapter 12, this chapter will rather focus on cerebrovascular disease as the cause of progressive gait and postural impairment, but with preserved isometric strength. Vascular disease causing this syndrome most often affects the supratentorial compartment in the form of lacunar disease or ischemic disease of the white matter. Less often, it involves the posterior circulation, affecting vestibular or cerebellar structures and, very rarely, other brainstem structures important for gait, such as the mesencephalic locomotor center or substantia nigra.
