Gait disorder described as 'Slipping Clutch Syndrome' occurs in

(D) Frontal gait disorder # FRONTAL GAIT DISORDER (gait apraxia) is common in elderly & has a variety of causes.> Term is used to describe a shuffling freezing gait with imbalance and other signs of higher cerebral dysfunction.> Typical features include a wide base of support a short stride shuffling along the floor & difficulty with starts and turns.> Many patients exhibit a difficulty with gait initiation that is descriptively characterized as the "slipping clutch" syndrome or gait ignition failure or lower-body parkinsonism.> Strength is generally preserved & patients are able to make stepping movements when not standing and maintaining their balance at the same time.> Higher-level motor control disorder as opposed to an apraxia.> Most common cause of frontal gait disorder is vascular disease particularly subcortical small-vessel disease.> Lesions are frequently found in the deep frontal white matter and centrum ovale.> Gait disorder may be the salient feature in hypertensive patients with ischemic lesions of the deep-hemisphere white matter (Binswanger's disease).> Clinical syndrome includes mental changes (variable in degree) dysarthria pseudobulbar affect (emotional disinhibition) increased tone and hyperreflexia in the lower limbs.> Communicating hydrocephalus in adults also presents with a gait disorder of this type.> Other features of the diagnostic triad (mental changes incontinence) may be absent in the initial stages.> MRI demonstrates ventricular enlargement an enlarged flow void about the aqueduct and a variable degree of periventricular white-matter change.> Lumbar puncture or Dynamic test is necessary to confirm hydrocephalus.