14. abnormal/unsteady gait Flashcards
name some abnormal gaits
equinas
high stepping
antalgic
trendelenberg
parkinsonian
ataxic
hemoplegic
diplegic
presentation equinas
“equine dressage”
This is where one foot is tip-toeing - heel not touching the ground
This is because the ankle is unable to dorsiflex
presentation high stepping gait
This is where the knees are brought up high so as to be able to place the heel down
The ankle has weakness of dorsiflexion so compensated through to avoid tripping
presentation antalgic gait
“the quick step”
This is where one leg spends little time in the stance phase due to pain
presentation trendelenberg gait
Caused by weak lower limb abductors
Pelvis fails to rise on lifted leg causing pt to compensate with upper body leaning over
(look at shoulder position
presentation parkinsonian gait
Slow initiation
Short step length
Reduced arm swing
“Shuffling gait”
Rigidity and bradykinesia
presentation ataxic gait
Broad base, staggering
presentation hemiplegic gait
Spastic flexion of UL and extension of LL
Due to extension of the lower limb, the leg is elongated meaning patients have to swing their leg round to prevent it dragging
presentation diplegic gait
flexion of UL and extension of LL on both sides leading to legs being swung around to avoid dragging
causes equinas gait
This is because the ankle is unable to dorsiflex
Cerebral palsy
Tight achilles eg in talipes
Limb length discrepancy
Autism spectrum disorder
causes of drop foot/high stepping gait
Direct injury to dorsiflexors
Common peroneal nerve injury
L5 radiculopathy
Peripheral neuropathy - motor loss predominant
causes antalgic gait
any cuase of lower limb pain
causes trendelenberg gait
L5 radiculopathy (weakness of hip abduction)
Painful hip pathology eg trochanteric bursitis
Femur neck fracture
Hip dislocation
Proximal muscle weakness but more so if unilateral
causes parkinsonian gait
parkinsons disease
drug induced parkinsonism
parkinsons plus syndromes (MSA and supranuclear pasly)
Normal pressure hydrocephalus
Lewy body dementia
Parkinsons dementia
wilsons disease
causes ataxic gait
- cerebellar
- sensory due to loss of proprioception (dorsal column sign)
- vestibular
causes hemiplegic gait
Cerebral palsy hemiplegic
CNS lesion
- Stroke
- Space-occupying lesion
- Trauma
- MS
causes diplegic gait
Spinal cord lesion
MND
Bilateral brain lesion
how to ddx the most common causes of footdrop
most common = common peroneal nerve palsy
L5 radiculopathy (weakness of hip abduction is suggetsive)
other causes: motor loss peripheral neuropathy
Presentaion guillian barre syndrome
symptoms:
- progressive symmetrical ascending weakness
- can have leg pain/back pain
- mild distal paraesthesia
signs:
- reflexes reduced or absent
- reduced sensation in a glove and stocking distribution
there may be a history of gastroenteritis
what is guilian barre
Guillain-Barre syndrome describes an immune-mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni).
what additional features of guillian barre should you check for? worrying ones?
respiratory muscle weakness
signs of DVT/PE
cranial nerve involvement
diplopia
bilateral facial nerve palsy
oropharyngeal weakness is common
autonomic involvement
urinary retention
diarrhoea
invetsigations ?guilian abrre
lumbar puncture
rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66%
nerve conduction studies may be performed
- decreased motor nerve conduction velocity (due to demyelination)
- prolonged distal motor latency
- increased F wave latency
LP findings guillian barre
rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66%
nerve conduction findings guillian barre
decreased motor nerve conduction velocity (due to demyelination)
prolonged distal motor latency
increased F wave latency