Chapter 25. Gait Disorders Flashcards
Question 25-1: Ataxia characterized by increased body sway and disequilibrium with a broad stance and broad gait suggests which localization of the lesion? A. Cerebral cortex B. Basal ganglia C Cerebellum D. Spinal cord
Answer 25-1: C.
Cerebellar ataxia is characterized by a broadbased
stance and gait along with increased
body sway and dysequilibrium. Limb ataxia
may occur along with gait ataxia, though this
is not invariable
Question 25-2: Ataxia which markedly worsens following eye closure is typical of which location? A. Basal ganglia B. Cerebellum C. Spinal cord D. Sensory nerves
Answer 25-2: D.
Sensory ataxia is typically exacerbated by loss
of visual input. Patients with other causes
including cerebellar ataxia may feel less
secure when the eyes are closed, but they do
not have a marked deterioration in gait.
Patients with sensory ataxia have a wide based
cautious gait, with slow steps. The gait is
often slapping as the feet are thrust ahead of
the body prior to landing
Question 25-3:
Which of the following causes of akinetic rigid syndrome can differentiate PSP from Parkinson’s disease?
A. Neck posture is flexed in PSP rather than extended as in PO
B. Neck posture is extended in PSP rather than flexed as in PO
C. Early loss of postural reflexes is seen in PO rather than PSP
D. Cognitive dysfunction is seen in PD but not PSP
Answer 25-3: B.
Neck posture is extended in PSP rather than
flexed as in PD. This gives a very different
appearance to the stance. Early loss of
postural reflexes helps to differentiate MSA
from PD: in which postural reflexes are
preserved until more advanced stages of the
disease. Cognitive dysfunction is seen in both
PD and PSP, and is not more prevalent in PD
Question 25-4: A young woman presents with a broad-based gait with a bouncing character. Clonus is easily elicited in the legs. The symptoms have been progressive over months and are associated with headache and mild cognitive difficulty. Which is the most likely diagnosis? A. Multiple sclerosis B. Spinocerebellar atrophy C Hydrocephalus D. Alcoholic cerebellar degeneration
Answer 25-4: C.
Hydrocephalus can result in a spastic ataxia -
the combination of spasticity and ataxia.
Arnold-Chiari malformation is another
important cause of this clinical presentation.
The gait is often described as bouncing or
springing, where there are compensatory
movements for the poor limb placement and
clonus which interferes with stance and gait
Question 25-5: Which of the following features suggest Parkinson's disease rather than symptomatic parkinsonism? A. Narrow based gait B. Shuffling gait C Freezing D. Hesitation to initiate gait
Answer 25-5: A.
Narrow-based gait is typical of Parkinson’s
disease, but many patients with symptomatic
parkinsonism have a wide-based gait. The
other symptoms listed. shuffling gait. freezing,
and difficulty starting gait are seen in both PD
and symptomatic parkinsonism and are not
differentiated features. Other features which
suggest PD are festination, relative
preservation of heel-toe walking, and relative
preservation of postural reflexes early in the
course ofthe disease
Question 25-6:
A patient presents with spastic left hemiparesis and is found on examination to have right facial weakness involving the lower face.
Select the most likely localization of the lesion.
A. Cerebral cortex
B. Pons
C Medulla.
D.Spinal cord
Answer 25-6: B.
Lesion in the pons can produce spastic hemiparesis along with facial weakness
ipsilateral to the lesion
Question 25-7:
A patient with spastic left hemiparesis is found on examination to have weakness of right shoulder shrug.
Select the most likely localization of the lesion.
A. Cerebral cortex
B. Pons
C Medulla.
D.Spinal cord
Answer 25-7: C.
Lesion of the medulla can produce hemiparesis along with defective shoulder shrug on the same side, when the descending corticospinal tracts have already crossed. This is an important differentiating feature from a cervical spine lesion in which shoulder shrug would be relatively unaffected
Question 25-8:
A patient presents with spastic left hemiparesis without any face involvement. Sensory examination shows sensory deficit for pain on the right side of the body.
Select the most likely localization of the lesion.
A. Cerebral cortex
B. Pons
C Medulla.
D.Spinal cord
Answer 25-8: D.
Lesion of the spinal cord can result in
hemiparesis with contralateral spinothalamic
sensory deficit, the Brown-Sequard syndrome.
The lack of involvement of any cranial nerves
takes the lesion out of the brainstem and into
the cervical cord.
Question 25-9: A patient presents with broad-based gait with short, shuffling steps. The posture is upright. Arm swing is exaggerated although there is loss of the normal truncal swing of gait. Which is the most likely diagnosis? A. Frontal lobe ataxia B. Parkinsonism C. Cerebellar ataxia D. Conversion reaction
Answer 25-9: A
frontal lobe ataxia can be due to a variety of
pathologies including hydrocephalus, anterior
cerebral artery infarction, tumors. Gait can be
broad based which can resemble cerebellar
ataxia, though the short shuffling steps
resemble parkinsonism. However, truncal
posture is upright and stiff with exaggerated
arm swing.
Question 25-10:
Gower’s sign is most likely seen in patients with which disorder?
A. Spastic hemiparesis from cerebral infarction
B. Cervical myelopathy
C. Multiple sclerosis
D. Duchenne muscular dystrophy
Answer 25-10: D.
Gower’s sign is commonly seen in myopathic
disorders including Duchenne muscular
dystrophy. The patient has difficulty with
proximal weakness which results in
destabilization of the pelvis and exaggeration
of rotation of the pelvis. Gower’s sign is the
use of the arms on the legs to rise to a
standing position. Whereas myopathies are the
most common causes, other important causes
are spinal muscular atrophy and GuillainBarre
syndrome.
