Walk with a large gait

Introduction Walking in a large gait is caused by deep sensory disturbances. It is characterized by a large stride length when walking, and a wide spacing between the legs. The foot is strong and the foot can be partially relieved when the eyes are gazing at the two eyes. When the eyes are closed, it is unstable or even unable to walk, often accompanied by a sensory disorder Romberg sign. Positive in subacute combined degenerative spinal cord nevus and so on. It is one of the clinical manifestations of gait abnormalities. Gait refers to the posture of the patient while walking. It is a complex exercise process that requires a high degree of coordination between the nervous system and the muscles, and involves many spinal reflexes and adjustments of the large and cerebellum, as well as the complete coordination of various posture reflexes, sensory systems, and motor systems. Therefore, observing gait often provides important clues to neurological diseases. Different diseases can have different special gaits, but gait is not the basis for diagnosis, but has a reference for diagnosis. Care should be taken to exclude gait abnormalities caused by bone deformities and bone, joint, muscle, blood vessels, skin and subcutaneous tissue.

Cause

1. Drunken gait: found 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.

5, panic gait: seen in the tremor paralysis and can cause tremor paralysis syndrome.

6, cross-threshold gait: See the general nerve paralysis and so on.

7, swing gait: seen in progressive muscular dystrophy. Polymyositis, pseudohypertrophic muscular dystrophy, and joint dislocation.

8, dance gait: seen in small chorea, chronic progressive chorea and other new striatum lesions.

9, star trail gait: seen in the vestibular labyrinth lesions.

10, gluteal muscle paralysis gait: one side of the gluteus medius lesion, polymyositis, progressive malnutrition and so on.

11, intermittent break: seen in spinal arterial endarteritis, spinal cord dysplasia, spinal stenosis, spinal vascular disease, subacute necrotizing vertebral inflammation, spinal cord compression and macrovascular disease affecting spinal cord blood supply.

12, cancerous gait: people who are seen in mental factors and ill temperament.

13, congenital myotonia: due to strong skeletal muscles when forced, so when walking or running, if you want to stop at that time, muscle tension can not immediately relax, and fall.

an examination

Related inspection

Brain CT examination brain MRI examination EEG examination brain nerve examination

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 be used for brain CT or MRI hemoptysis routine anti-chain "O" autoantibody examination.

9 star trail gait can be used for vestibular function examination.

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

Differential diagnosis

Differential diagnosis of walking in a large gait:

1. Drunk gait: Because the center of gravity is not easy to control, the distance between the legs is widened when walking. After lifting the leg, the body swings to the sides and the upper limbs often swing horizontally or forward or backward. Sometimes you can't stand still, it's more stable when you change your position, you can't take a straight line. This gait is also called " gait", which is seen in the ataxia caused by cerebellar lesions, such as cerebellar tumor, cerebrovascular disease, tumor, inflammation, degeneration, cerebellopontine angle tumor, olive bridge cerebellar degeneration, alcohol toxicity Cerebellar degeneration, cancerous spinal cerebellar degeneration. Cerebellar atrophy, cerebellar encephalitis, brainstem tumor, posterior inferior cerebellar artery thrombosis, frontal lobe lesion, inner ear vertigo, vestibular neuronitis, etc.

2, sensory ataxia gait: This refers to people with deep sensory impairment. It is characterized by a large stride when walking, a wide spacing between the legs, a high foot lift, a strong foot hitting the ground, two eyes gazing at the two feet, partial relief when blinking, unstable or even walking when closing the eyes. Often accompanied by sensory disturbances, Romberg sign positive, seen in subacute combined degenerative spinal cord paralysis.

3, spasticity hemiplegia gait: When hemiplegia, the affected limb lower limbs due to high extensor muscle tension and longer, and flexion is difficult. When the patient walks, the coordinated swinging motion of the upper limbs of the hemiplegia disappears, and the adductor, pronation and flexion postures are performed. The lower limbs are straightened and externally rotated. When the steps are raised, the pelvis is raised, and the toe is dragged outward to move forward and then to the front. Therefore, it is also called a circle-like gait. It is caused by damage of one side of the pyramidal tract, which is more common in cerebrovascular diseases.

4, sputum paraplegia gait: Due to the increased tension of the lower extremity adductor muscle group, the legs cross the inside when walking, shaped like scissors, it is also called scissors gait. Found in transverse spinal cord injury, cerebral palsy and so on.

5, panic gait: due to increased body muscle tension, slow start, walking small steps, rubbing the feet, the two upper limbs swinging back and forth the joint action lost, the trunk leaned forward, the center of gravity moved forward, so take a small step Rush forward, such as chasing the center of gravity and can not stop immediately, like a panic, also known as chasing the heart gait or rushing gait. Seen from tremor paralysis and diseases that can cause tremor paralysis syndrome.

6, cross-threshold gait: Because the diseased foot is drooping, in order to make the toes off the ground, the limbs are lifted very high, such as crossing the threshold. Seen in the general nerve paralysis and so on.

7. Swing gait: Due to the weakness of the pelvic muscles and the lower back muscles, the lower limbs and the pelvic muscles are atrophied. When standing, the lordosis of the spine is used to maintain the balance of the center of gravity of the body. When walking, the pelvis cannot be fixed due to the muscle weakness, so the hips swing like a duck. Also called duck step. Found in progressive muscular dystrophy.

8. Dance gait: There are large, irregular and involuntary movements of the limbs while walking. The lower extremity suddenly squats, the upper limbs are twisted, the road is unstable, and it is jumping or dancing. Found in the lesions of the new striatum.

9. Star trail gait: When the patient closes his eyes, he is inclined to the affected side, and when he retreats, he is deflected in the opposite direction. The advance and the backward are repeated, and the footprint is star-shaped. Found in the vestibular labyrinth lesions.

10, gluteal muscle paralysis gait: one side of the gluteus medius lesion, the torso bends to the affected side while walking, and swings left and right. Found in gluteus medius lesions, polymyositis, progressive malnutrition, etc.

11, spinal cord intermittent break: the performance of the beginning of walking asymptomatic, to a certain distance (about 1-5 minutes), one side or both sides of the lower limbs weakness, improved after a break. Found in spinal arterial endarteritis, spinal cord dysplasia, spinal stenosis.

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

13. Congenital myotonia: When the force is strong, the skeletal muscle is strong and straight, so when walking or running, if you want to stop at that time, the muscle tension can not be relaxed immediately, causing a fall.

As far as possible to find out the cause of gait abnormalities and targeted gait training. However, it is necessary to pay attention to the abnormal gait caused by some muscle spasms, such as gluteus maximus gait, gluteus musculature, etc. It is a functional compensatory phenomenon that cannot be corrected by gait training. If the muscle strength cannot be recovered, only the stent is used. Instead of muscle function exercises, the gait is improved.

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