Structural disconnectome analysis of acute freezing of gait due to parietal stroke: implications for FOG pathogenesis

Acute onset isolated freezing of gait (FOG) is a rare and defying diagnosis. Its pathophysiology is not yet totally understood and several brain regions seem to be involved. Postlesional FOG can help to shed light on the networks involved. We report a case of an 80-year-old woman who presented to the emergency department with acute onset impairment of gait. Her medical history was unremarkable. On neurological examination she was presented with difficulties in gait initiation, turning and progressing through narrow spaces. Her remaining neurological examination was unremarkable. Brain CT showed a subacute cortico-subcortical right parieto-occipital infarction. Acute isolated FOG due to parieto-occipital stroke was diagnosed. A structural disconnectome analysis showed that the lesion disrupted structural connections with the ipsilateral ventral striatum. This case highlights that acute onset FOG might be a consequence of a parietal cortical lesion.