Examination of coordination and gait

Question 1

give an example of a dementing disease

Answer 1

Alzheimer’s disease

Question 2

give an example of a movement disorder

Answer 2

Parkinson’s disease

Question 3

Give an example of a motor neuron disease

Answer 3

ALS

Question 4

What are EPS signs indicative of basal ganglia disorder?

Answer 4

resting tremor, hypokinesis (rigidity/bradykinesia), hyperkinesis (chorea/athetosis/akathesia)

Question 5

What are EPS signs of cerebellar disorders?

Answer 5

Ataxia (3D’s), dysequilibrium, hypotonia, action tremor, nystagmus

Question 6

What distinguishes pyramidal dysfunction from EPS?

Answer 6

pyramidal: arises from cortex/corticospinal tract –> WEAKNESS. Dysfunction of voluntary movement

Question 7

describe hemiparetic gait

Answer 7

Patient holds one arm to the side, drags affected leg in semicircle. Weakness of distal muscles, extensor hypertonia in lower limb. UMN injury (eg; hemispheric stroke)

Question 8

describe diplegic gait

Answer 8

walking with abnormally narrow base, dragging legs and scraping toes. Spasticity in lower extremities > upper extremities. Seen with bilateral periventricular lesions (cerebral palsy)

Question 9

describe neuropathic gait

Answer 9

aka: equine gait. weak dorsiflexion –> pt must lift leg high so foot doesn’t drag while walking.
Unilateral: peroneal nerve palsy, L5 radiculopathy.
Bilateral: ALS, Charcot-Marie-Tooth, uncontrolled diabetes

Question 10

describe myopathic gait

Answer 10

aka: waddling gait.
unilateral hip girdle weakness –> drop in pelvis on contralateral side while walking (Trendelenburg sign).
Bilateral weakness –> pelvis drops on both sides –> waddling
Seen in myopathies (muscular dystrophy)

Question 11

Describe bradykinetic gait

Answer 11

aka: Parkinsonian gait. Walks with stooped posture, knee flexion, slow and small steps. Seen in Parkinson’s

Question 12

Choreiform gait

Answer 12

aka: hyperkinetic gait
Irregular, jerky, involuntary movements in all extremities
Seen in Hungtington’s disease

Question 13

Ataxic gait

Answer 13

Clumsy, staggering movements with wide-based gait. Standing still –> body swinging back and forth, side-to-side (titubation)
Seen in: cerebellar disease, acute alcohol intoxication, cerebellar vermis disease (truncal instability)

Question 14

Sensory gait

Answer 14

loss of proprioceptive input when feet touch the ground –> patient slams foot to sense the ground. Exacerbated in the dark.
Seen in dorsal column disorders (B12 deficiency/tabes dorsalis) and peripheral nerve dysfunction (uncontrolled diabetes)

Question 15

What are the pathological characteristics of Multiple System atrophy

Answer 15

oligodendroglial alpha synuclein-immunoreactive inclusions in limbic system, brainstem, and/or basal ganglia

Question 16

Describe Shy-Drager syndrome

Answer 16

Multiple System atrophy involving Intermediolateral column degeneration and gliosis. Alpha-synuclein-immunoreactive argyrophilic glial cytoplasmic inclusions

Question 17

What are the three primary “tauopathies”?

Answer 17

Alzheimer’s disease, Frontal lobe degeneration of non-Alzheimer type, and Pick disease

Question 18

What tauopathies are associated with EPS?

Answer 18

Progressive supranuclear palsy (PSP) and Cortical Basal Degeneration (CBD)

Question 19

What are the primary characteristics of Progressive Supranuclear Palsy?

Answer 19

akinesia, rigidity, characteristic supranuclear gaze palsy

Question 20

What are the primary characteristics of Corticobasal degeneration?

Answer 20

initially clumsy and stiff, later rigid and akinetic

Question 21

What are the pathological characteristics of Huntington’s disease?

Answer 21

progressive atrophy of neostriatum (anterior caudate and dorsal putamen)

Question 22

What are the genetic characteristics of Friederich’s ataxia?

Answer 22

autosomal recessive. Chromosome 9q. GAA repeat expansion –> mitochondria dysfunction

Question 23

How does Friedreich’s ataxia manifest clinically?

Answer 23

limb ataxia, dysarthria, loss of distal position and vibration sense, upper limb wasting