Apraxia gait

Introduction In the absence of any sensory impairment or weakness, the ability to use the lower limbs to walk is lost due to bilateral frontal lobe lesions. Caused by bilateral frontal lobe lesions, common in hydrocephalus or progressive dementia. The patient has no physical weakness or ataxia, but cannot stand or walk on his or her own, showing gait instability, uncertainty, and small steps. The foot seems to stick to the ground with obvious hesitation (freezing) and dumping. 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.

Cause

(1) Causes of the disease

The common causes of abnormal gait are as follows:

1. Cortical spinal cord lesions can lead to spastic hemiplegic gait and spastic paraplegia.

2. Bilateral frontal lobe lesions can lead to a lost gait.

3. Frontal (cortical or white matter) lesions can lead to small gait (marcheà petit pas).

4. Extrapyramidal lesions can lead to panic gait and distorted, odd asynchronous state.

5. Cerebellar lesions lead to ataxia gait.

6. Alcohol or barbiturate poisoning leads to drunken gait.

7. Others have sensory disturbances leading to ataxia gait; due to weakness of the tibialis anterior and gastrocnemius muscles, leading to cross-threshold gait; trunk and pelvic muscle weakness leading to myopathy gait; palpitations caused by psychogenic diseases.

an examination

Related inspection

EEG examination of brain CT

First, medical history

Observing gait can often provide clues to important neurological diseases. Attention should be paid to the time incentives for gait abnormalities, the age of the patients, whether the gait abnormalities are persistent or intermittent, and whether there are other symptoms such as limb pain and infection of inflammatory tumors. Nutritional deficiency of intramuscular injection history, history of chopping, family history, history of cerebral vascular disease and syphilis infection.

Second, physical examination

During the examination, the patient can be walked normally. If necessary, the patient can be closed for further examination. The patient can suddenly turn and stop when checking. Pay attention to the size of the posture of the posture of the foot and the falling position, the rhythm and the direction. Skewed.

Third, auxiliary inspection

Gait abnormalities select different auxiliary tests depending on their nature and location.

1, drunken gait with cerebellar lesions more common 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 is more likely to have spinal cord lesions, spinal MRI cerebrospinal fluid examination, electromyogram and somatosensory evoked potential should be selected.

3, spastic hemiplegia gait is more common in sequelae of cerebrovascular disease, brain CT or MRI can be selected.

4, spastic paraplegia gait according to the situation can choose spinal or brain CT or MRI examination.

5, panic gait can choose brain CT or MRI EEG.

6, cross-threshold gait can do EMG examination.

7, swing gait can do EMG myelogram X-ray film.

8, dance gait can do brain CT or MRI hemoptysis routine anti-chain "O" autoantibody examination.

9, star trail gait can do vestibular function check.

10, spinal cord intermittent break should be used for spinal cord CT or MRI spinal angiography lower extremity arterial blood flow map.

Differential diagnosis

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. It is more obvious that the gait cannot be taken straight. This gait is also called " gait".

2, sensory ataxia gait: This refers to the deep sensory dysfunction is characterized by a large stride when walking, the legs are wider, the foot is higher, the foot is strong, the ground eyes can be partially relieved when the eyes are blinking 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 subacute combined degenerative spinal cord.

3, spasmodic hemiplegic gait: the hemiplegia of the affected side of the lower extremity due to high extensor muscle tension, and the patient's flexion of the upper limbs of the hemiplegic side of the patient with flexion is disappearing, showing a pre-rotation flexion posture, lower extremity straightening And when the external rotation step, the pelvis is raised, in order to avoid the toe dragging the ground and then moving to the front, it is also called the circle-like gait, which is caused by the damage of one side of the pyramidal tract.

4, sputum paraplegia gait: due to the increased tension of the lower extremity adductor muscles caused by walking the legs to the inside of the cross shape, such as scissors, also known as scissors gait, seen in the transverse spinal cord damage cerebral palsy.

5, panic gait: due to the increase in muscle tension at the beginning of the body when walking slowly, the pace of small feet rubbing the ground and the two upper limbs before and after the swing of the joint movement lost the torso forward tilting the heart forward, so the small step rapid forward as if chasing The center of gravity and the inability to stop immediately seem to be panic, also known as chasing the gait or rushing gait seen in tremor paralysis and diseases that can cause tremor paralysis syndrome.

6, cross-threshold gait: due to the sagging of the diseased foot in order to make the toes off the ground, the limbs are lifted very high, such as the posture of crossing the threshold is seen in the common paralysis of the sacral nerve.

7, swing gait: due to pelvic muscles and psoas muscle weakness lower limbs and pelvic muscle atrophy when standing to make the lordosis, in order to maintain the body's center of gravity balance, walking muscles can not be fixed due to muscle weakness, so the hips swing like a duck, Also known as duck step is seen in progressive muscular dystrophy.

8. Dance gait: There is a large irregular involuntary movement of the limb during walking. The lower extremity suddenly has an external paralysis and the upper limb is twisted and the road is unstable. It is a jumping or dance-like appearance, which is seen in the lesion of the new striatum.

9. Star trail gait: When the patient moves backwards to the affected side and then retreats in the opposite direction, the deviation in the opposite direction is so advanced and backward that the footprint is star-shaped and is seen in the vestibular labyrinth lesion.

10, gluteal muscle paralysis gait; one side of the gluteus medius lesions when walking torso to the affected side, and swinging left and right in the gluteus medius lesions polymyositis, progressive malnutrition.

11, spinal cord intermittent break: the performance of the beginning of walking asymptomatic to a certain distance (about 1-5 minutes), one or both sides of the lower extremity weakness after rest, improved, seen in spinal artery endarteritis spinal cord dysplasia spinal canal stenosis Wait.

12, rickety gait: can be expressed in a variety of strange gait, such as gait gait gait often accompanied by other functional disorders.

13. Congenital myotonia: When the force is strong, the skeletal muscles are strong and straight, so when walking or running, if you want to stop the muscle tension, you can't immediately relax and fall.

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