פרק 6 Chapter 6 Disorders of Stance and Gait

Question 1

Normal pressure hydrocephalus מה ינבא הצלחה של שאנט ?
א. חדרים גדולים
ב. לחץ פתיחה תקין בניקור
ג. אתיולוגיה של פוסט מנינגיטיס
ג. ירידה קוגניטיבית קלה בהתייצגות

Answer 1

ג. אתיולוגיה של פוסט מנינגיטיס

Question 2

Answer 2

תשובה א. שיפור אחרי הוצאת נוזל

Question 3

הליכה בצעדים קטנים על בסיס רחב היא:
פרונטלית
פרקינסונית
המיפלגית

Answer 3

פרונטלית
with starting to walk, short steps, widened base, difficulty
lifting the feet off the floor (the magnetic gait)
and a tendency to fall backwards (retropulsion). In all
likelihood, the medial frontal lobes embody automatic
programs for walking that are intimately tied to adjacent
networks in the striatum.

Standing and walking may be severely disturbed by diseases that affect the frontal lobes, particularly their medial parts and their connections with the basal ganglia no weakness, loss of sensation, cerebellar incoordination, or basal ganglionic abnormality. Patients with the so-called apraxia of gait do not have apraxia of individual limbs; conversely, patients with apraxia of the limbs usually walk normally. More likely, the frontal gait disorder represents a loss of integration, at the cortical and basal ganglionic levels, of the essential elements of stance and locomotion that are acquired in infancy and often lost in old age.
Patients typically assume a posture of slight flexion with the feet placed farther apart than normal. They advance slowly, with small, shuffling, hesitant steps. At times they halt, unable to advance without great effort, although they improve if escorted, or if instructed to walk in step with the examiner or to a cadence. Walking and turning are accomplished by a series of tiny, uncertain steps that are made with one foot, the other foot being planted on the floor as a pivot.

Question 4

בן70 עם הפרעה מתקדמת בהליכה. בבדיקתו הליכה שפופה, לא יציבה עם צעדים קטנים כאילו רגליו “נדבקו” לריצפה , מבצע סיבוב עם ריבוי צעדים קטנים. ללא נוקשות או איטיות של הגפיים העליונות. בשכיבה על המיטה אין חולשת שרירים, והוא מסוגל לעשות תנועות שמדמות רכיבה על אופניים באוויר. מהי הפתולוגיה המתאימה ?

א. Glial alpha-synuclein cytoplasmic inclusions
ב. Loss of neurons and gliosis positive for tau staining
ג. Neurofibrillary tangles and amyloid plaques
ד. Vascular damage to white matter

Answer 4

ד. vascular damage to white matter

Question 5

Answer 5

א. מיאלופתיה שגורמת לUMN זו התשובה.

A spastic paraparetic gait is the major manifestation of cerebral diplegia (Little disease, a type of cerebral palsy), the result of anoxic or other damage to the brain in the perinatal period. This disorder of gait is also seen in a variety of chronic spinal cord diseases involving the dorsolateral and ventral tracts, most often multiple sclerosis, but also including syringomyelia, any type of chronic meningomyelitis, subacute combined system disease of both the pernicious anemia and nonpernicious anemia types, spinal cord compression or traumatic injury, adrenomyeloneuropathy, and familial forms of spastic paraplegia. Frequently in these diseases, the effects of posterior column disease are added, giving rise to a mixed gait disturbance—a spinal spastic ataxia, characteristic of multiple sclerosis and certain spinal cord degenerations such as Friedreich ataxia.
ההדמיות האחרות-
ב. NPH
ג. trident (omega) sign of central pontine myelinolysis
ד. פגיעה בקאודה אקווינה

Question 6

Answer 6

תשובה ב. gluteus medius

This gait is characteristic of the gluteal muscle weakness that is seen in the progressive muscular dystrophies, but it occurs as well in chronic forms of spinal muscular atrophy, in certain inflammatory myopathies, lumbosacral nerve root compression, and with congenital dislocation of the hips.
In normal walking, as weight is placed alternately on each leg, the hip is fixated by the gluteal muscles, particularly the gluteus medius, allowing for a slight rise of the opposite hip and tilt of the trunk to the weight-bearing side. With weakness of the glutei, however, there is a failure to stabilize the weight-bearing hip, causing it to bulge outward and the opposite side of the pelvis to drop, with inclination of the trunk to that side. The alternation in lateral trunk movements results in the roll or waddle.

Question 7

Table 6-1FEATURES OF GAIT ABNORMALITIES

Answer 7

Question 8

Figure 6-1. The normal gait cycle, based on the studies of Olsson and of Murray et al. See text for details.

Answer 8

Question 9

Figure 6-2. Schematic depiction of three of the main disorders of gait, described further in the text.
A. Hemiplegic gait on the right.
B. Spastic gait with close approximation of the feet and legs and flexion at the knees.
C. Parkinsonian gait with forward position of the upper torso, flexion of the neck and elbows, and short-stepped gait. This may be contrasted with the similar but distinctive gait of aging (Fig. 6-3).

Answer 9

Question 10

Figure 6-3. Diagram illustrating the changes in posture and gait that accompany aging (“senile gait”). With aging (figure on left), there occurs a decrease in the length of stride, excursion of the hip, elevation of the toes of the forward foot and the heel of the rear foot, shoulder flexion on forward arm swing, and elbow extension on backward swing.

Answer 10