abnormal gait
Introduction
Introduction Gait abnormalities can be caused by movement or sensory disturbances, and their characteristics are related to the lesion site. Can be seen in many nervous system or other system diseases, some typical abnormal gait, has a suggestive meaning for certain diseases, can be diagnosed by looking around. For some atypical gait, it is necessary to make a detailed examination. Through analysis and synthesis, it will also help the diagnosis. Clinical classification of gait abnormalities should be combined with the cause. It shows a grotesque gait. Although the muscle strength of the lower limbs is good, it can't support the weight. It swings in all directions and seems to fall. When walking, the gait is dragged, but it is rare to fall.
Cause
Cause
1. Drunken gait: seen in cerebellar tumor, cerebrovascular disease, tumor, inflammation, degeneration, cerebellopontine angle tumor, olive bridge cerebellopontine degeneration, alcoholic cerebellar degeneration, cancerous spinal cerebellar degeneration J brain atrophy J encephalitis, brain stem tumor, posterior inferior cerebellar artery thrombosis, frontal lobe lesion, inner ear vertigo, vestibular neuronitis, etc.
2, sensory ataxia gait: seen in subacute combined degeneration, spinal cord hernia, hereditary ataxia, posterior cord lesions, diabetes and cancerous neuropathy.
3, spastic hemiplegic gait: seen in cerebrovascular disease, encephalitis, brain trauma and other sequelae.
4, spastic paraplegia gait: seen in spastic paraplegia, cerebral palsy, transverse spinal cord injury, cerebral palsy, hereditary spastic paralysis, lateral sclerosis, corticospinal degeneration.
Examine
an examination
Related inspection
Brain CT examination EEG examination Brain ultrasound examination serum phenylalanine
First, medical history
Observing gait often provides clues to important neurological diseases. Should pay attention to the timing of gait abnormalities, incentives, age of patients, gait abnormalities are persistent or intermittent, with or without other symptoms such as limb pain, infection, inflammation, tumor. Nutritional deficiencies, history of arthroplasty, family history, history of cerebrovascular disease, history of syphilis infection, etc.
Second, physical examination
The patient can be walked normally during the examination and closed eyes if necessary. Further examination can cause the patient to suddenly turn, stop, and so on. Pay attention to the conditions of starting and stopping, the posture of stretching and falling, the size of the steps, the rhythm and the direction.
Third, auxiliary inspection
Gait abnormalities select different auxiliary tests depending on their nature and location.
1, drunken gait: more common cerebellar lesions, clinical choice of brain CT or MRI, if you consider brain stem involvement should choose brain MRI, can also be supplemented with EEG.
2, sensory ataxia gait: the possibility of spinal cord lesions should choose spinal MRI, cerebrospinal fluid examination, electromyogram and somatosensory evoked potential.
3, spastic hemiplegic gait: more common cerebrovascular disease sequelae can choose brain CT or MRI.
4, spastic paraplegia gait: depending on the situation, spinal or brain CT or MRI examination can be selected.
5, panic gait: you can choose brain CT or MRI, EEG examination.
6, cross-threshold gait: can do EMG examination.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from the following symptoms:
1. Drunk gait: Because the center of gravity is not easy to control, the distance between the legs is widened when walking. After the leg is lifted, the body swings to the sides. The upper limb often shakes in the horizontal direction or before or after, sometimes it cannot stand, and it is unstable when changing position. More obvious, it is not possible to take a straight line for diagnosing cerebellar or vestibular system disorders. When the cerebellum or vestibular system is damaged, the muscles of the upper and lower limbs are weakened, the distance between the upper limbs is poor, or the balance of the trunk is poor. Therefore, the stride is large, the step is widened, and the trunk is shaken and drunk.
2. Duck step or swing step: It is a common sign of congenital dislocation of the bone. Patients with unilateral dislocation have claudication, bilateral dislocation, standing pelvis forward, standing behind the buttocks, bulging at the waist, abdomen bulging, swinging left and right while walking Therefore, it is called a duck step or a swing step. It is slightly faster to walk, that is, it is easy to fall.
3. gluteal muscle paralysis gait: is a side of the gluteus medius lesion, polymyositis, progressive malnutrition.
