9 Ataxia and Gait Disturbances

Question 1

Examples of gait disorders

Answer 1

1. Cerebellar motor ataxic gait
2. Gait of sensory ataxia
3. apraxic gait
4. Festinating gait
5. gait of hemiparesis
6. waddling gait
7. functional gait disorder

Question 1

cerebellar motor gait

Answer 1

widely based with unsteady and irregular steps,
and compensation to barriers in the environment may be lacking

Question 2

gait of sensory ataxia

Answer 2

results from loss of proprioception
abrupt movement of the legs and
slapping impact of the feet with each step

Question 3

apraxic gait

Answer 3

patient seemingly has lost the ability to initiate the process of walking
“ignition failure”
may occur with right or nondominant hemispheric lesions

Question 4

festinating gait

Answer 4

narrowly based miniature shuffling steps
common in Parkinson’s disease

Question 5

gait of hemiparesis

Answer 5

outward swinging or circumabduction of the leg
reflects asymmetric weakness of the proximal lower extremity musfcles

Question 6

waddling gait

Answer 6

bilateral weakness of the trunk and pelvic girdle muslces
failure to maintain the normal position of the pelvis relative to the lower extremities

Question 7

functional gait dirsorder

Answer 7

the underlying problem is often a conversion disorder
a dramatic functional gait with flailing movements without falling actually demonstrates that strength, balance, and coordination are intact

Question 8

remarks on gait testing

Answer 8

Gait testing is one of the most important parts of the directed neurologic examination.
Do not assume a normal examination without observing ambulation.

Question 9

These indicate a lateral cerebellar lesion

Answer 9

Dyssynergia (breakdown of movements into parts)
Dysmetria (inaacurate fine movements)
Dysdiadochokinesia (clumsy rapid movements)

Question 10

Romberg test

Answer 10

Positive when unsteadiness worsens upon closing the eyes - **sensory ataxia with possible problem in posterior column or vestibular dysfunction)

Negative when no change in unsteadiness with eye closure - motor ataxia, possible cerebellar problem

Question 11

other causes of posterior column dysfunciton

Answer 11

tabes dorsalis (neurosyphilis)
Vitamin B12 deficiency

Question 12

remarks on nystagmus

Answer 12

Presence of nystagmus suggests that the pathologic process is intracranial (CNS or vestibular)
and not in the spinal cord or peripheral nervous system

Question 13

approach in ataxia

Answer 13

1. First task is to determine whether the ataxia is sensory or motor and whether the primary process is **systemic or within the nervous system
2. Next question: PNS vs CNS, and where specifically

Question 14

ataxia in the alcoholic patient

Answer 14

Wernicke’s disease
Ataxia
Confusion
*Eye movement abnormalities

Administer IV thiamine

Question 15

Acute cerebellar ataxia of childhood is thought to be a

Answer 15

postinfectious demyelinating disorder