Differentials Abnormal Gait

Question 1

Differentials Hemiplegic Gait

Answer 1

Stroke/Cerebrovascular accident 
Tumour/space occupying lesion 
Trauma
IVH
Demyelinating condition 
Spastic hemiplegia CP

Question 2

Differentials Spastic Diplegia

scissor / crouch gait with continously bent knees, hips and ankles

Answer 2

Cerebral palsy
Inherited
Myelomeningocele (spina bifidia)

Question 3

Differentials Ataxic Gait

SENSORY ATAXIA (peripheral nerve/posterior column) - wide based, high stepping, positive Romberg = loss of balance with closed eyes. Impaired vibration sense

CEREBELLAR ATAXIA - staggering
= loss of balance with open eyes. May have nystagmus, dysmetria, dysdiadodochinesia

VESTIBULAR ATAXIA - vertigo, nausea, vomiting

Answer 3

CAUSES:
Cerebellar - Tumours, stroke, MS, B12 defiency, Fredrichs/spinocerebellar ataxia, paraneoplastic, drugs e.g. phenytoin, lithium

Sensory - peripheral neuropathy e.g CMT

Broad causes:
Hereditary ataxia = Ataxia telangectasia, Fredrich’s ataxia
Infection = cerebellitis
Neurodegenerative conditions
Nutritional = Vit E/B12 deficiency
Malignancy = neuroblastoma, posterior fossa tumour, medulloblastoma
Intoxication/ingestion e.g. anticonvulsant
Trauma
IVH
Labyrinthitis/vertigo
Metabolic = maple syrup urine

Question 4

Differentials Myopathic Gait

(weakness of hip abductors, waddling appearance) + Trendelenberg

Answer 4

Systemic Disease - dermatomyositis, hypo/hyperthyroid, Cushing

Muscular dystrophies - DMD, BMD, myotonic dystrophy
= + GOWER’s sign

Question 5

Differentials Foot Drop

Answer 5

Isolated peroneal nerve palsy
Peripheral neuropathy e.g. CMT, diabetic neuropathy
L5 radiculopathy (disc prolapse)

Question 6

Differentials Antalgic Gait

PAIN

Answer 6

Arthritis
Inflammatory joint disease
Trauma
Fracture 
Nerve entrapment e.g. sciatica