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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).
Examination of the Nervous System
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Tim Fowler, John Scadding, Nick Losseff
Certain gait disorders are readily recognized: In a spastic gait, the patient walks slowly, with stiffness in the legs and sometimes scissoring due to thigh adductor spasm. The feet are plantar flexed and inverted and the toes scuff the ground. A hemiplegic gait is characterized by dragging, weakness and spasticity of one leg.The patient with an ataxic gait is unsteady and adopts a wide-based stance, and tends to lurch from side to side on walking.The Parkinsonian gait is typified by a stooped posture, difficulty in initiating walking (start hesitation), small shuffling steps with a tendency to gain pace (festinant gait).A waddling gait is produced by proximal weakness at the hip girdle. There is an inability to tilt the pelvis normally when swinging each leg through to take the next step, and this is compensated by exaggerated lateral movements of the trunk, producing a waddling motion.A steppage gait results from severe weakness of dorsiflexion of the feet, combined with impairment of position sensation. In order to clear the ground with each step, there is exaggerated flexion at the hip. There may also be associated stamping of each foot on the ground, particularly when weakness is associated with severe postural sensory loss.In an apraxic gait, the patient is able to stand, but unable to perform the planned sequence of motor function necessary for walking. The gait most often appears small-paced and shuffling.A limping gait is a very common observation, and usually not the result of any neurological deficit, but rather, a painful musculoskeletal condition affecting the leg or lumbar spine. The gait appears protective and when associated with pain, is also sometimes called an antalgic gait.
Hereditary motor and sensory neuropathy type VIA with optic nerve pallor in two sisters with pathologic myopia: a case series and review
Published in Ophthalmic Genetics, 2023
Kevin Babu, Kimberly Seamon, Ann Jewell, Anna Harrison, Amy Harper, Hind Al Saif, Natario Couser
The second patient, the 15-year-old full sister of Case 1, was born full term to a non-consanguineous couple from a 33-year-old mother of German and English descent and a 32-year-old father of European descent. She had early onset nystagmus and started wearing glasses at 3 months of age. History was also notable for delayed language development and a diagnosis of autism spectrum disorder received at age 4. At age 13, her mother noticed development of abnormal gait, frequent falls when ambulating, and increased difficulty with fine motor tasks. On neurological evaluation at this time, she was found to have decreased strength and muscle bulk in distal upper and lower extremities. Reflexes were found to be diminished throughout. Sensation was intact to light touch with mild decrease in vibration. She was found to demonstrate a high steppage gait. Based on these findings and her family history, she was given a clinical diagnosis of Charcot–Marie–Tooth. Genetic testing for CMT1A/HNPP PMPP22 gene was completed with negative results.
Microscopic polyangiitis: an incidental finding in a patient with stroke
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Abubakar Tauseef, Muhammad Sohaib Asghar, Mariam Amir, Maryam Zafar, Ayesha Anum, Haris Alvi, Mustafa Dawood, Uzma Rasheed, Mohammed Akram, Nisar Ahmed
Our case describes a 39-year-old female with a past medical history of diabetes mellitus, hypertension and recurrent abortions who presented to us with the complaints of left foot drop, rash, joint pain more in knees and small joint of hands, followed by drooping of eyelid and deviation of angle of mouth after 2 days. Examination revealed steppage gait, facial muscle weakness of right side and calf tenderness. Laboratory tests included increase Erythrocyte sedimentation rate, increased C-reactive protein and positive P ANCA-anti myeloperoxidase (MPO). On Sural nerve biopsy nerve bundle fibers showing inflammatory cell infiltrate with lymphocyte positive on immune-histochemical stain CD3. All these features were suggestive of non-granulomatous polyangiitis. MRI brain showed multiple abnormal signals in the subcortical areas of the left side of the brain, suggestive of stroke in a middle-aged female patient due to fragile vessels, because of the underlying vasculitis.
Harel Yoon syndrome: a novel mutation in ATAD3A gene and expansion of the clinical spectrum
Published in Ophthalmic Genetics, 2023
Caroline Atef Tawfik, Raghda Zaitoun, Aliaa Ahmed Farag
On examination, the boy demonstrated a clear high steppage gait with bilateral foot drop and a positive Rhomberg’s sign. He had clear axial hypotonia of neck and trunk as well as decreased tone of hip adductors and hip flexors together with bilateral spastic ankles. In terms of muscle power, the boy had bilateral symmetrical weakness more proximal than distal. The weakness was observed both in lower and upper limbs though it was more evident in the former. In the lower limbs, weakness was more in flexors than in extensors, while in upper limbs, weakness affected extensors more than flexors. Facial weakness and ptosis were both fatiguable at the time of examination. Bulbar affection was also evident, with depressed palatal and gag reflexes.