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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Sep;67(3):345–352. doi: 10.1136/jnnp.67.3.345

Progressive frontal gait disturbance with atypical Alzheimer's disease and corticobasal degeneration

M Rossor 1, P Tyrrell 1, E Warrington 1, P Thompson 1, C Marsden 1, P Lantos 1
PMCID: PMC1736536  PMID: 10449557

Abstract

OBJECTIVES—The clinical neuropsychological, neuroradiological, and neuropathological description of two patients presenting with a frontal gait disturbance.
METHODS—Clinical case note review, neuropsychological assessment, functional imaging with 15O2 and 18F-fluorodopa PET, and neuropathology.
RESULTS—Both patients presented with frontal gait impairment and only later developed more widespread cognitive impairment. In both cases 15O2 PET disclosed focal hypometabolism in the medial frontal lobes and in one patient 18F-fluorodopa uptake into the caudate and putamen was normal. The neuropathological examination in one patient showed Alzheimer's histopathology together with large swollen eosinophilic neurons characteristic of corticobasal degeneration, which were particularly prominent in the medial frontal lobes.
CONCLUSION—Focal degeneration of the medial frontal lobes may present as an isolated gait disturbance and should be considered in the differential diagnosis of patients who present without an obvious structural abnormality on neuroimaging.



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Selected References

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  1. Atchison P. R., Thompson P. D., Frackowiak R. S., Marsden C. D. The syndrome of gait ignition failure: a report of six cases. Mov Disord. 1993 Jul;8(3):285–292. doi: 10.1002/mds.870080306. [DOI] [PubMed] [Google Scholar]
  2. Ball J. A., Lantos P. L., Jackson M., Marsden C. D., Scadding J. W., Rossor M. N. Alien hand sign in association with Alzheimer's histopathology. J Neurol Neurosurg Psychiatry. 1993 Sep;56(9):1020–1023. doi: 10.1136/jnnp.56.9.1020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blin J., Vidailhet M. J., Pillon B., Dubois B., Feve J. R., Agid Y. Corticobasal degeneration: decreased and asymmetrical glucose consumption as studied with PET. Mov Disord. 1992 Oct;7(4):348–354. doi: 10.1002/mds.870070409. [DOI] [PubMed] [Google Scholar]
  4. Brion S., Jedynak C. P. Troubles du transfert interhémisphérique (callosal disconnection). A propos de trois observations de tumeurs du corps calleux. Le signe de la main étrangére. Rev Neurol (Paris) 1972 Apr;126(4):257–266. [PubMed] [Google Scholar]
  5. DENNY-BROWN D. The nature of apraxia. J Nerv Ment Dis. 1958 Jan;126(1):9–32. doi: 10.1097/00005053-195801000-00003. [DOI] [PubMed] [Google Scholar]
  6. DENNY-BROWN D. The nature of apraxia. J Nerv Ment Dis. 1958 Jan;126(1):9–32. doi: 10.1097/00005053-195801000-00003. [DOI] [PubMed] [Google Scholar]
  7. Fisher C. M. Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology. 1982 Dec;32(12):1358–1363. doi: 10.1212/wnl.32.12.1358. [DOI] [PubMed] [Google Scholar]
  8. Frackowiak R. S., Lenzi G. L., Jones T., Heather J. D. Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure, and normal values. J Comput Assist Tomogr. 1980 Dec;4(6):727–736. doi: 10.1097/00004728-198012000-00001. [DOI] [PubMed] [Google Scholar]
  9. Friston K. J., Passingham R. E., Nutt J. G., Heather J. D., Sawle G. V., Frackowiak R. S. Localisation in PET images: direct fitting of the intercommissural (AC-PC) line. J Cereb Blood Flow Metab. 1989 Oct;9(5):690–695. doi: 10.1038/jcbfm.1989.97. [DOI] [PubMed] [Google Scholar]
  10. Goldberg G., Mayer N. H., Toglia J. U. Medial frontal cortex infarction and the alien hand sign. Arch Neurol. 1981 Nov;38(11):683–686. doi: 10.1001/archneur.1981.00510110043004. [DOI] [PubMed] [Google Scholar]
  11. Hyman B. T., Trojanowski J. Q. Consensus recommendations for the postmortem diagnosis of Alzheimer disease from the National Institute on Aging and the Reagan Institute Working Group on diagnostic criteria for the neuropathological assessment of Alzheimer disease. J Neuropathol Exp Neurol. 1997 Oct;56(10):1095–1097. doi: 10.1097/00005072-199710000-00002. [DOI] [PubMed] [Google Scholar]
  12. Lammertsma A. A., Jones T. Correction for the presence of intravascular oxygen-15 in the steady-state technique for measuring regional oxygen extraction ratio in the brain: 1. Description of the method. J Cereb Blood Flow Metab. 1983 Dec;3(4):416–424. doi: 10.1038/jcbfm.1983.67. [DOI] [PubMed] [Google Scholar]
  13. Laplane D., Talairach J., Meininger V., Bancaud J., Orgogozo J. M. Clinical consequences of corticectomies involving the supplementary motor area in man. J Neurol Sci. 1977 Dec;34(3):301–314. doi: 10.1016/0022-510x(77)90148-4. [DOI] [PubMed] [Google Scholar]
  14. Mirra S. S., Heyman A., McKeel D., Sumi S. M., Crain B. J., Brownlee L. M., Vogel F. S., Hughes J. P., van Belle G., Berg L. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease. Neurology. 1991 Apr;41(4):479–486. doi: 10.1212/wnl.41.4.479. [DOI] [PubMed] [Google Scholar]
  15. Munoz-Garcia D., Ludwin S. K. Classic and generalized variants of Pick's disease: a clinicopathological, ultrastructural, and immunocytochemical comparative study. Ann Neurol. 1984 Oct;16(4):467–480. doi: 10.1002/ana.410160408. [DOI] [PubMed] [Google Scholar]
  16. Nagahama Y., Fukuyama H., Turjanski N., Kennedy A., Yamauchi H., Ouchi Y., Kimura J., Brooks D. J., Shibasaki H. Cerebral glucose metabolism in corticobasal degeneration: comparison with progressive supranuclear palsy and normal controls. Mov Disord. 1997 Sep;12(5):691–696. doi: 10.1002/mds.870120510. [DOI] [PubMed] [Google Scholar]
  17. Nutt J. G., Marsden C. D., Thompson P. D. Human walking and higher-level gait disorders, particularly in the elderly. Neurology. 1993 Feb;43(2):268–279. doi: 10.1212/wnl.43.2.268. [DOI] [PubMed] [Google Scholar]
  18. Patlak C. S., Blasberg R. G., Fenstermacher J. D. Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data. J Cereb Blood Flow Metab. 1983 Mar;3(1):1–7. doi: 10.1038/jcbfm.1983.1. [DOI] [PubMed] [Google Scholar]
  19. Petrovici I. Apraxia of gait and of trunk movements. J Neurol Sci. 1968 Sep-Oct;7(2):229–243. doi: 10.1016/0022-510x(68)90145-7. [DOI] [PubMed] [Google Scholar]
  20. Sawle G. V., Brooks D. J., Marsden C. D., Frackowiak R. S. Corticobasal degeneration. A unique pattern of regional cortical oxygen hypometabolism and striatal fluorodopa uptake demonstrated by positron emission tomography. Brain. 1991 Feb;114(Pt 1B):541–556. doi: 10.1093/brain/114.1.541. [DOI] [PubMed] [Google Scholar]
  21. Schneider J. A., Watts R. L., Gearing M., Brewer R. P., Mirra S. S. Corticobasal degeneration: neuropathologic and clinical heterogeneity. Neurology. 1997 Apr;48(4):959–969. doi: 10.1212/wnl.48.4.959. [DOI] [PubMed] [Google Scholar]
  22. Spinks T. J., Guzzardi R., Bellina C. R. Performance characteristics of a whole-body positron tomograph. J Nucl Med. 1988 Nov;29(11):1833–1841. [PubMed] [Google Scholar]
  23. Thompson P. D., Marsden C. D. Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger's disease. Mov Disord. 1987;2(1):1–8. doi: 10.1002/mds.870020101. [DOI] [PubMed] [Google Scholar]
  24. Tsuchiya K., Ikeda K., Uchihara T., Oda T., Shimada H. Distribution of cerebral cortical lesions in corticobasal degeneration: a clinicopathological study of five autopsy cases in Japan. Acta Neuropathol. 1997 Nov;94(5):416–424. doi: 10.1007/s004010050728. [DOI] [PubMed] [Google Scholar]
  25. Tyrrell P. J., Sawle G. V., Ibanez V., Bloomfield P. M., Leenders K. L., Frackowiak R. S., Rossor M. N. Clinical and positron emission tomographic studies in the 'extrapyramidal syndrome' of dementia of the Alzheimer type. Arch Neurol. 1990 Dec;47(12):1318–1323. doi: 10.1001/archneur.1990.00530120062011. [DOI] [PubMed] [Google Scholar]
  26. Tyrrell P. J., Warrington E. K., Frackowiak R. S., Rossor M. N. Heterogeneity in progressive aphasia due to focal cortical atrophy. A clinical and PET study. Brain. 1990 Oct;113(Pt 5):1321–1336. doi: 10.1093/brain/113.5.1321. [DOI] [PubMed] [Google Scholar]
  27. Tyrrell P., Rossor M. The association of gegenhalten in the upper limbs with dyspraxia. J Neurol Neurosurg Psychiatry. 1988 Jul;51(7):995–997. doi: 10.1136/jnnp.51.7.995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Watson R. T., Fleet W. S., Gonzalez-Rothi L., Heilman K. M. Apraxia and the supplementary motor area. Arch Neurol. 1986 Aug;43(8):787–792. doi: 10.1001/archneur.1986.00520080035016. [DOI] [PubMed] [Google Scholar]

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