Practice Paper 4: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
The tibial nerve is particularly vulnerable to damage during posterior dislocations of the knee. It can also be compressed in the posterior tarsal tunnel behind the medial malleolus. A branch of the sciatic nerve, the tibial nerve supplies the flexor compartment of the leg (calf muscles). It also gives rise to the medial and lateral plantar nerves, which supply the intrinsic muscles of the foot as well as plantar sensation. Tibial nerve palsy results in loss of toe flexion, ankle inversion and the ankle jerk. Sensation over the plantar surface of the foot is lost. Affected patients walk with a shuffling gait, as the take-off phase of walking is impaired. There is loss of the lateral longitudinal arch of the foot, and atrophy of the intrinsic foot muscles eventually results in a claw foot.
Movement disorders
Henry J. Woodford in Essential Geriatrics, 2022
The neuropathological findings of DLB include Lewy bodies, which are spherical, eosinophilic, intracytoplasmic inclusion bodies composed of alpha-synuclein protein. They may be found throughout the brain but appear more commonly in the basal ganglia and limbic system. Standardised diagnostic criteria are available for DLB.98 Diagnosis typically requires dementia plus two or more of the key clinical features as listed above. Parkinsonism eventual appears in over 85% of people with DLB.98 Resting tremor is uncommon. Shuffling gait and impaired motor initiation are likely. Visual hallucinations occur in around 80%. Diagnostic accuracy remains challenging. It is estimated that around 20% of DLB diagnoses are incorrect when compared to autopsy cerebral pathological findings.99
Distribution
Kerry Layne, Albert Ferro, Janice Rymer in 100 Cases in Clinical Pharmacology, Therapeutics and Prescribing, 2020
The patient is alert and orientated to time, place and person. He has no visible injuries. Cardiovascular, respiratory and abdominal system examinations are unremarkable. Neurological examination identifies bilateral increased tone in the upper limbs with a pronounced resting tremor, consistent with ‘cogwheel rigidity’. There is a slow, rhythmic ‘pill-rolling’ tremor in the left hand. The patient’s face appears expressionless, or ‘mask-like’ and his speech is monotonous. He walks with a shuffling gait.
Neuroprotective effect of standardized extracts of three Lactuca sativa Linn. varieties against 3-NP induced Huntington’s disease like symptoms in rats
Published in Nutritional Neuroscience, 2022
Jai Malik, Supreet Kaur, Maninder Karan, Sunayna Choudhary
Gait abnormality: Gait abnormality was assessed in order to evaluate the motor coordination, particularly of the hind limbs. Narrow bean walk apparatus, that has been very effective in detecting the motor incapabilities in rats, was used for assessing gait abnormalities. The apparatus consists of 50 cm wooden strip supported by two pedestals, elevated at a height of 1 m above the ground, at each end (with a box at one end) so that the animal attempts to reach the box due to acrophobia. The rats were allowed to transverse the narrow beam, and the time taken to transverse the narrow beam from the start point to the box was recorded with a cutoff time of 120 s after which the animal was removed and placed in the cage. All the rats were given a prior training session during −1 and 0 day before starting their evaluation which was done on day 1, 5, 10 and 15.21
Spinal cord stimulation for gait disturbances in Parkinson’s disease
Published in Expert Review of Neurotherapeutics, 2023
Nora Vanegas-Arroyave, Joseph Jankovic
Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease, with an estimated number of 1.2 million cases in North America by 2030 [1]. In addition to tremor, bradykinesia, and rigidity, PD patients exhibit a variety of other motor symptoms including shuffling gait, postural instability and freezing of gait (FOG) [2–6]. The latter is characterized by transient periods during which the individual is unable to produce effective steps when initiating gait (start hesitation), moving through narrow passages, or turning, often described by the patient as ‘the feet are stuck to the floor’ [7,8]. Compared to non-freezers, PD patients with FOG have longer disease duration, more severe motor fluctuations, take higher doses of dopaminergic agents, and are more likely to exhibit cognitive impairment [4]. Phenotypically, the vast majority of patients with FOG (89%) belong to the postural-instability-gait difficulty (PIGD) subtype of PD [4,9]. Because of its sudden and unpredictable nature, FOG is an important cause of falls and a major contributor to the increased morbidity and mortality of patients with PD [3,10,11]. Gait disturbances in PD (particularly FOG), have a notable clinical impact on patients’ quality of life due to reduced mobility, loss of independence, social embarrassment, and caregiver burden [12,13].
Cutaneous Granulomatosis and Class Switching Defect as a Presenting Sign in Ataxia-Telangiectasia: First Case from the National Iranian Registry and Review of the Literature
Published in Immunological Investigations, 2020
Parisa Amirifar, Reza Yazdani, Tannaz Moeini Shad, Alireza Ghanadan, Hassan Abolhassani, Martin Lavin, Soheila Sotoudeh, Asghar Aghamohammadi
Gait abnormality is usually the first diagnostic criterion of A-T, appearing in the first years of life. Telangiectasia is the second important clinical manifestation of the disease, having its onset commonly after the age of 3 years (Jozwiak 2005). Measurement of serum AFP concentration is another diagnostic hallmark, as it is increased in more than 90 to 95% of patients with A-T (Stray-Pedersen et al. 2007). In our patient, despite a large deletion in the ATM gene, predicted to result in ATM protein loss, the first clinical symptoms were skin lesions and autoimmunity, while ataxia and telangiectasia appeared after 6 years of age. This atypical manifestation caused at hree-year delay between the appearance of initial symptoms and the final diagnosis of A-T. Early diagnosis improves both the quality of life and survival in patients with A-T by antibiotic therapy and vaccination, IVIg substitution, limitation of exposure to ionizing radiation, and physiotherapy for respiratory symptoms (Navratil et al. 2015). Moreover, early diagnosis helps genetic counseling for the identification of the carriers who have an elevated risk of malignancy, especially breast cancer in women and may also reduce the risk of another child with A-T in the family (Swift et al. 1991).
Related Knowledge Centers
- Gait
- Nervous System
- Musculoskeletal System
- Trendelenburg'S Sign
- Limp
- Myopathic Gait
- Antalgic Gait
- Peripheral Neuropathy
- Paresthesia
- Sense of Balance