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Clinical management
Published in Alistair Burns, Michael A Horan, John E Clague, Gillian McLean, Geriatric Medicine for Old-Age Psychiatrists, 2005
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean
This is classically a scissor gait with bilateral leg weakness. The legs are stiff and steps are short. The knees are adducted and may cross during walking. There is little ankle movement. The toes may be dragged along the floor. The reflexes are usually exaggerated and there is a sensory level indicating the level of the spinal cord that is damaged. Bladder function is usually impaired. Patients with m�ltiple sclerosis often have additional cerebellar involvement and there may be trembling as the foot makes contact with the floor.
Gait examination
Published in Hani Ts Benamer, Essential Revision Notes in Clinical Neurology, 2017
➤ The following are the classic gait abnormalities: ➣ Hemiplegic gait – the lower limb moves in a semicircle, the toe scraping the floor with each step, and the arm is held in a flexed position close to the chest.➣ Spastic gait – a stiff, scissor gait with the legs crossing in front of each other while walking.➣ Ataxic gait – patient’s gait is wide-based ‘drunken gait’ with difficulty performing heel-to-toe test. Patients with sensory ataxia usually have severe impairment of joint position and vibration. Patients usually stamp their feet on the floor when walking. Sensory ataxia is usually due to subacute combined degeneration of the cord (vitamin B12 deficiency).➣ Parkinsonian gait – patient walks with small steps and shuffles. Patient stoops with lack of arm swing and the arms are held in flexed positions.➣ Steppage gait – patient lifts the foot high during walking to avoid scraping the toes and foot slapping. This is due to foot drop.➣ Waddling gait – There is lumbar lordosis and the patient’s legs are wide apart. The trunk moves from side to side with the pelvis dropping. This is usually due to hereditary muscular dystrophies.➣ Gait apraxia, marche à petits pas and lower-body Parkinsonism – different terms describing patients with difficulty in starting to walk with small, shuffling steps. This is an indication of diffuse cerebrovascular ischaemic disease (small-vessel disease).
Hereditary and idiopathic spastic paraparesis: preliminary findings of a single center experience
Published in Neurological Research, 2018
Fang Cui, Liuqing Sun, Jie Qiao, Jianmei Xiong, Yangang Zhao, Jianyong Li, Mao Li, Siyu Chen, Xusheng Huang
Among the 56 patients in this study, there were more males than females (2.5:1), which is in line with Proukakis et al.’s study [12]. In addition, our study showed that males had a significantly higher severity score than females, which is also in agreement with Proukakis et al.’s finding [12]. Taken together, our results demonstrated that compared to males, female patients had an older age at onset and less severe symptoms of HSP. However, it should be pointed out that the imbalance sample size between male and female may affect the comparison results. In this study, the common manifestations included increased deep tendon reflexes in the lower extremities, positive Babinski sign, increased muscle tone of lower extremities, scissors gait, ankle clonus, reduced muscle strength in the lower extremities and skeletal deformities. The incidences of each manifestation are mainly the same as those in a report in 2003 by Zhao et al. [14]. The most common skeletal deformities are high arch foot and foot drop. Fonknechten et al. have reported that about half of HSP patients have sphincter dysfunction, manifesting as frequent urination [15]. However, we found only five (8.9%) of HSP patients had urinary disorders. It is worth to further investigate if the incidence of sphincter dysfunction is associated with specific subtypes of HSP.
A new compound heterozygous mutation in adult-onset Krabbe disease
Published in International Journal of Neuroscience, 2020
Xianghe Meng, Yingjiao Li, Yajun Lian, Yujuan Li, Liyuan Du, Nanchang Xie, Cui Wang
The proband of this family was a 48-year-old male farmer. He visited our neurology unit due to asymmetric muscle weakness in his legs with gait impairment, without any other symptoms. His history of past illness was unremarkable and there was no consanguinity between his parents. At 40 years of age, the patient noticed weakness in his left lower limb and the symptom deteriorated progressively. At age 46, he noticed weakness in his right lower limb and walking problems. Muscle weakness then progressively developed in both lower limbs over the next 2 years, predominantly on the left side. On neurologic examination, he was alert, oriented, cooperative, and had no difficulties with speech. The patient achieved 28 marks in the Mini-Mental State Examination (MMSE). The patient’s visual acuity and fields were intact with normal ophthalmoscopic examination and other cranial nerve functions were intact. Muscle strength and muscle tension of the upper limbs were normal. The lower limbs showed muscle weakness with muscle strengths of 3 to 4/5 on the left side and 4/5 on the right side according to the Medical Research Council grade and muscle tension in both lower limbs were enhanced. The deep tendon reflexes in the patient’s upper extremities were normal and the deep tendon reflexes in both lower extremities were hyperactive. The patient’s Babinski signs and Chaddock signs were positive, whereas Hoffmam signs were negative and pes cavus was found on both sides. The patient’s superficial and deep sensations were normal. The patient was presented with a scissor gait. No dysautonomia was noted. A detailed review of his family history was negative for the presence of neurological and psychiatric diseases. Recently, the patient’s brother exhibited similar neurological symptoms of lower limb weakness (Figure 1).