Spastic paraplegic gait

Introduction The spastic paraplegia is a neurodegenerative degenerative disease. The pathological changes are mainly axonal degeneration and/or demyelination of the bilateral corticospinal tract in the spinal cord, with the heaviest thoracic segment. The clinical manifestations were increased muscle tension in both lower limbs, active sputum reflexes, positive pathological reflexes, and scissor gait. The age of onset is generally 3 to 5 years old, all male. In addition to spastic paraplegia, there is extra-spinal damage.

Cause

Found in spastic paraplegia, cerebral palsy, transverse hereditary spasticity, hereditary spastic paralysis, lateral sclerosis, corticospinal degeneration and other diseases.

(1) Type I: Type I patients develop before the age of 35. Most patients with simple HSPI are male. The age of onset of AR-HSP is usually 3 to 6 years old or 10 years old.

(2) Type II: Patients with simple HSPII type develop after 35 years of age. AD-HSP has a late onset age, with an average age of 18 years. The pyramidal tract sign is obvious, and there are often sensory disturbances and sphincter disorders.

an examination

Related inspection

Random exercise examination for brain CT examination

Diagnosis: According to family history, childhood (a few 20 to 30 years old), slow progressive lower extremity paralysis, scissors gait, optic nerve atrophy, extrapyramidal symptoms, ataxia, muscle atrophy, dementia and skin lesions Wait.

Laboratory examination: the blood, urine, stool, cerebrospinal fluid routine tests are normal.

Other auxiliary inspections:

1. CT and MRI: There may be a thinning and atrophy of the spinal cord.

2. Due to the damage of the posterior cord of the spinal cord, the somatosensory evoked potential of the lower limb cortex is abnormal, the latency is prolonged, and the amplitude is decreased, indicating that the nerve conduction velocity is slowed down.

Differential diagnosis

1 drunken gait: because the center of gravity is not easy to control, the distance between the legs is widened when walking, and the body swings to the sides after the leg is lifted. The upper limb often shakes in the horizontal direction or before or after, sometimes it cannot stand, and the position is unstable when changing position. Obviously, it is impossible to take a straight line. This kind of gait is also called "".

2 Sensory ataxia gait: This refers to the deep sensory dysfunction caused by a large stride when walking, the legs are wider, the foot height is higher, and the foot is strong and the ground eyes can be partially relieved when looking at the two eyes. When the eye is closed, it is unstable or even unable to walk. It is often accompanied by a sensory disorder. The Romberg sign is positive in the subacute combined degenerative spinal cord.

3 : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : When the external rotation step is carried out, the pelvis is raised. In order to avoid the toe towing the ground and then move outward and then move forward to the front, it is also called a circle-like gait, which is caused by a lesion of one side of the pyramidal beam and is more common in cerebrovascular diseases.

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