Neurology

Question 1

What is an antalgic gait?

Answer 1

This is a painful gait, whey are trying to get off the painful leg and there is an abnormal shortened stance phase and swing phase is increased.

Question 2

What is antalgic gait caused by?

Answer 2

Pain in the lower extremity

Hip or knee pathology

Question 3

What is trendelenburg gait?

Answer 3

Abnormal gait that is found in people with weak abductor muscles of the hip which are supplied bu the superior gluteal nerves.
They are unable to abduct their hip

Question 4

What are the stages of gait?

Answer 4

Stance (60%)

Swing (40%)

Question 5

What are the causes of trendelenburg gait?

Answer 5

Avulsion of the abductor muscle tendon

L5 radiculopathy

Question 6

What is a hemiplegic gait

Answer 6

Caused by a lesion in the CNS which results in unilateral weakness and spasticity

Patients with hemiplegia exhibit spastic flexion in the upper limb and extension of the lower leg

Due to extension of the lower limb, the leg is elongated meaning patients have to circumduct their leg to prevent their foot from dragging on the groud

Question 7

What are the causes of hemiplegic gait?

Answer 7

Stroke
Space occupying lesions
Trauma
MS

Question 8

What other signs would you expect with a hemiplegic gait?

Answer 8

Increased tone with clasp knife spasticity 
Hyperreflexia
Upgoing plantars 
Reduced power
Sensory deficit

Question 9

What is diplegic gait caused by?

Answer 9

Lesion in the CNS (stroke/complete transection of the spinal cord)

This is very similar to hemiplegic but is bilateral

Spasticity is worse in lower limbs compared to upper

This is the one where knees are flexed whilst ankles are extended and internally rotated

Question 10

What are the causes of diplegic gait?

Answer 10

Cerebral palsy 
Spinal cord lesion 
Multiple sclerosis 
Bilateral brain infarcts 
Motor neurone disease
Midline tumour

Question 11

What are the causes of parkinsonian gait?

Answer 11

Vascular parkinsons disease
Dementia with lewy bodies
Certain meds- antipsychotics antiemetics
Parkinson plus syndromes- progressive supranuclear palsy

Question 12

What is ataxic gait caused by?

Answer 12

Broadly cerebellar, decreased sensory impairment, vestibular

Question 13

What are the clinical features of ataxic gait?

Answer 13

Clinical features associated with cerebellar ataxia:

Nystagmus
Ataxic dysarthria
Dysmetria
Intention tremor 
Dysdiadokokinesia
Clinical features associated with sensory ataxia:

Positive Romberg’s sign
Impaired proprioception
Impaired vibration sensation
Absence of other cerebellar signs (e.g. dysmetria, nystagmus, dysarthria)
Clinical features associated with vestibular ataxia:

Vertigo
Nausea
Vomiting

Question 14

What causes cerebellar ataxia?

Answer 14

Cerebellar stroke
Multiple sclerosis
Space occupying lesion 
Alcoholism 
B12 deficiency 
Drugs - lithium 
Genetic disease
Paraneoplastic disease

Question 15

What causes sensory ataxia?

Answer 15

Peripheral neuropathy- diabetes mellitus

Question 16

What are the causes of vestibular ataxia?

Answer 16

Labyrinthitis, menieres, acoustic neuroma

Question 17

What are the clinical features of neuropathic gait?

Answer 17

Clinical features which may be associated with a neuropathic gait include:

Peripheral vascular disease
Peripheral sensory impairment
Distal muscle weakness
Reduced or absent reflexes

Question 18

What is neuropathic gait (high steppage)

Answer 18

Neuropathic gait (a.k.a. high-steppage gait) is caused by weakness of the muscles in the distal limb (typically the dorsiflexors of the foot) as a result of damage to the peripheral nerves providing motor innervation.

Weakness of the dorsiflexors of the foot results in foot drop and dragging of the toes during the swing phase of the gait cycle. To prevent the toes from dragging on the floor, the knee and hip flex excessively, thereby creating a “high stepping” gait.

Question 19

What are the causes of foot drop?

Answer 19

Foot drop is caused by weakness of the muscles of ankle dorsiflexion (tibialis anterior) supplied by the common peroneal nerve (L4, L5 and S1 nerve root).

Foot drop may therefore be caused by:

Isolated common peroneal nerve palsy (e.g. secondary to trauma or compression)
L5 radiculopathy (e.g. disc prolapse)
Generalized polyneuropathy involving multiple nerves (e.g. diabetic neuropathy, motor neurone disease, Charcot-Marie Tooth disease)