Movement + Gait Disorders

Question 1

Spastic

Answer 1

Stiff
Circumduction of legs + scuffing of toe of shoes
UMN lesions

Question 2

Extrapyramidal

Answer 2

Flexed posture
Shuffling feet, slow to start
Postural instability
e.g. Parkinson’s

Question 3

Apraxic

Answer 3

Gluing to floor on attempting to walk
Wide based unsteady gait with tendency to fall
Normal pressure hydrocephalus + multi-infarct states

Question 4

Ataxic gait

Answer 4

Wide base, falls
Can’t walk heel-to-toe
Worse in dark/with eyes closed
Cerebellar/proprioception deficits

Question 5

Myopathic gait

Answer 5

Waddling gait

Can’t climb steps or stand from sitting due to hip girdle weakness

Question 6

Psychogenic

Answer 6

Bizzare gait not conforming to other patterns

No signs when examined on couch

Question 7

Tremors and their features

Answer 7

Rest tremor - abolished on voluntary movement (e.g. Parkinsonism)
Intention tremor - Irregular large amplitude, worse at end of purposeful acts (e.g. cerebellar damage)
Postural tremor - Absent at rest but worse on maintained posture (e.g. benign essential, thyrotoxicosis, anxiety, beta-agonists)
Re-emergent tremor - postural tremor after 10s delay (e.g. Parkinson’s disease)

Question 8

Chorea and features

Answer 8

Non-rhythmic jerky fidgety movements

Caused by huntington’s, levodopa

Question 9

Hemiballismus and features

Answer 9

Large amplitude, flinging hemichorea affecting proximal muscles contralateral to vasc lesion of STN (often in elderly diabetics)

Question 10

Athetosis and features

Answer 10

Slow purposeful movements similar to chorea
Caused by CP most commonly
Pseudoathetosis caused by proprioceptive loss

Question 11

What are tardive syndromes

Answer 11

Delayed onset, can be irreversible symptoms following dopamine antagonist exposure e.g. antipsychotics/emetics

Question 12

Tardive syndrome types

Answer 12

Tardive dyskinesia - e.g. chewing grimacing movements
Tardive dystonia - twisting/turning e.g. back arching
Tardive akathisia - restlessness, repetitive movements e.g. pacing
Tardive myoclonus
Tardive tourettism
Tardive tremor

Question 13

Treating tardive dyskinesia

Answer 13

Gradually withdraw neuroleptics + wait 3-6 mths

Tetrabenazine may help

Question 14

Dystonia types

Answer 14

Idiopathic generalised (genetic part, ACh inhibitors may help)
Focal dystonia (botox may help)
Acute dystonia as torticollis, trismus + oculogyric crisis on starting neurleptics (anti-ACh may help)