Hysterical gait

Introduction Gait abnormalities can be caused by movement or sensory disturbances, and their characteristics are related to the lesion site. Hysteric gait: It can express grotesque gait. Although the muscle strength of the lower limbs is good, but it can not support the weight, it swings in all directions and seems to fall. When walking, the gait is dragged, but it is rare to fall. Seen in heart disease.

Cause

The cause of snoring gait:

A gait gait caused by a heart disease.

an examination

Related inspection

Brain ultrasound examination of brain CT examination of electrocardiogram serum glucagon (PG)

Hysteric gait examination and diagnosis:

Through comprehensive analysis, symptom diagnosis is based on the characteristics of the asynchronous state, and the cause diagnosis is further considered. Gait needs to be observed:

1. The length of the stride.

2. Walking speed.

3. Bilateral symmetry.

4. Flexibility of movement.

5. Coordinated movement of the upper limbs (too little or too much).

6. The position of the head and shoulders.

7. Coordination of the trunk (forward or backward, left or right).

8. Activity of the pelvis (front, back, left, right).

9. The state of the heel of the heel and the shift of the center of gravity during walking.

10. The length of the footing period (the period of the heel strikes the ground) and the length of the foot (the period when the toes are off the ground), the mutual ratio, and the relationship with the movement of the trunk. The gait of each normal person should be distinguished by various factors such as height, weight, self-child habits (such as external eight-step, inner eight-step), personality, walking speed, mental state, fatigue, and excitement.

Differential diagnosis

Symptoms of vaginal gait confusing:

(1) Cortical spinal cord disease: 1 sacral hemiplegia gait: unilateral lesion. The upper limbs of the diseased side are usually flexed and adducted, the waist is inclined to the healthy side, the lower limbs are straight and externally rotated, and the front swings outward (compensating for the hip, knee flexor and dorsiflexion caused by weakness), while walking A circled gait; mild patients only show lower limb towing gait. Found in the sequela of stroke and so on. 2 sacral paraplegia gait: bilateral severe paralytic muscle tension increased, patients with lower limbs tonic adduction, with compensatory trunk movement, walking effort, scissor-like gait. Common in children with cerebral palsy, spinal cord trauma and so on.

(2) Disappeared gait: 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.

(3) small gait (marcheà petit pas): seen in the frontal lobe (cortex or white matter) lesions. Small steps, towing, slow start or turn, unstable gait. Misdiagnosed as Parkinson's disease gait, but small gait is the base width. The upper limbs have swinging motion, with cognitive impairment, frontal lobe release symptoms, pseudobulbar palsy, pyramidal tract dysfunction, and sphincter dysfunction. However, it should be noted that patients with frontotemporal dementia can also be combined with Parkinson's disease.

(4) Extrapyramidal lesions:

1 flustered gait: seen in advanced Parkinson's disease. When walking, the torso bends forward, the hips, knees and ankles bend, the start is slow, the difficulty of stopping and the difficulty of turning, the small gait rubbing the ground, showing a forward flush, easy to fall. The upper limb synergy swing disappears.

2 dystonia is characterized by abnormal posture of the limb or trunk, which can affect movement or lead to distortion, odd asynchronous state.

(5) Cerebellar ataxia gait:

1 cerebellar sacral lesions lead to trunk ataxia, irregular gait, awkwardness, instability and wide base, difficult to turn, can not go straight. Found in the cerebellar midline tumor and spinal cerebellar ataxia.

2 Cerebellar hemisphere lesions lead to gait instability or coarse jumping action (dance-like gait), shaking left and right, tilting to the disease side, the vision can be partially corrected, often accompanied by poor limb discrimination. Found in cerebellar lesions and multiple sclerosis.

(6) drunken gait: seen in alcohol or barbiturate poisoning. The gait is squatting, shaking, and tilting back and forth. It seems to fall out of balance and cannot be corrected by vision. The difference from the cerebellar ataxia gait is that drunken people can walk a short distance and maintain balance on a narrow basal plane, while cerebellar ataxia is always a broad base gait.

(7) Sensory ataxia gait: seen in Friedreich ataxia, subacute combined spinal degeneration, multiple sclerosis, spinal cord spasm and sensory neuropathy. The patient can't stand with closed eyes, and it is easy to fall when shaking. When the eye is blinking, the vision can be partially compensated (Romberg sign); when walking, the lower limbs are heavy, high, and heavy, and when walking or closing eyes, it is aggravated.

(8) Cross-threshold gait: seen in common peroneal nerve palsy, sacral muscular atrophy and progressive spinal muscular atrophy. Due to the weakness of the tibialis anterior and gastrocnemius muscles, the limbs are raised when walking, such as across the threshold.

(9) Myopathy gait: seen in progressive muscular dystrophy. Due to the weakness of the trunk and pelvis with muscles leading to lordosis, the hips swing side to side as they walk, like a duck step.

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