Localization skills: dizziness, abnormal balance or gait

Question 1

List the s/s of syncope.

Answer 1

Vision dimming, sweatiness, tacycardia, sense of feeling “faint”
- Can have incontinence

Question 2

List the causes of syncope.

Answer 2

• Orthostatic hypotension
• Vasovagal (frightening/emotional experience, straining)
• Carotid sinus pressure, heart block, arrhythmia, etc.

Question 3

What tests check for syncope?

Answer 3

Orthostatics, checking BP in both arms, cardiac ausculation

Question 4

List the s/s of vertigo.

Answer 4

Sensation of room spinning/body being pushed or pulled

Question 5

What additional descriptions distinguish vertigo in:

• Acute labrynthitis
• BPV
• Meniere’s dz

Answer 5

• Acute labrynthitis: +/- a/w nausea/inability to walk
• BPV: provoked w/positional change
• Meniere’s dz: Recurrent w/deafness/tinnitus

Question 6

Name and explain the test that checks for vertigo.

Answer 6

Dix-Hallpike test
- Patients are lowered quickly to a supine position w/ the neck extended by the clinician performing the maneuver. A positive test is indicated by patient report of a reproduction of vertigo and clinician observation of nystagmus.

Question 7

What does broad-based ataxic gait look like?

Answer 7

Feet spread apart for balance, unsteadiness w/ tandem gait, heel-toe

Question 8

What types of lesions produce broad-based ataxic gait?

Answer 8

Lesions of the posterior columns or proprioceptive sensory nerve or cerebellar dysfunction (can be worse with eyes closed)

Question 9

Describe hemiplegic gait.

What disease leads to this?

Answer 9

Affected lower limb stiffly extended and swung/circumducted when walking; ipsilateral upper limb flexed @ elbow and wrist w/ decreased arm swing

Stroke pts

Question 10

Describe tabetic gait.

What diseases lead to this?

Answer 10

Foot slapping (compensation for impaired sensation by forcibly planting feet to feel floor)

Neurosyphilis and tabes dorsalis, or even severe polyneuropathy

Question 11

Describe steppage gait.

What nerve’s lesion would lead to this gait (_____ nerve or what dermatome)?

Answer 11

To prevent tripping over toes, the hip is flexed or pulled up even higher to elevate the drooping foot, which is then lowered to the floor toe first

Foot drop or weak dorsiflexion of the foot; peroneal nerve or L5 nerve root lesion

Question 12

Describe waddling gait.

What diseases lead to this?

Answer 12

Hip and pelvic muscles support the weight of the pt on one leg when the other is elevated with compensatory bending or leaning of the trunk to the left foot as the right foot is raised (and vice-versa) → alternative tilting of pelvis that resembles walking duck

Weakness of the hip girdle muscles, usually seen in myopathy

Question 13

Describe scissoring gait.

What diseases lead to this?

Answer 13

Advancing foot tends to cross over the opposite lower limb like the crossing blades of a scissors. Gait is due to increased spastic tone in adductor muscles which forces the lower limbs together when walking.

• UMN (corticospinal tract) lesions affecting lower limbs; spastic paraparesis (ex. Cerebral palsy)

Question 14

Describe Parkinsonian gait.

What diseases lead to this, besides PD?

Answer 14

Slow and shuffling, decreased arm swing, stooped/bent over posture

Ataxic gait