Unsteady gait

Introduction Unstable gait means that the patient walks unsteadily, or sees that the movement is not flexible. When walking, the legs are wide; or when walking, you can't walk straight, suddenly left and right; or when walking, the steps are short, and the two upper limbs do not swing back and forth. When I first walked slowly, I became more and more fast, and I was in a gait.

Cause

When the spinal cord, brainstem, vestibule, cerebellum, and cerebral cortex lesions cause the above-mentioned reflexes to be unable to coordinate the completion of muscle lesions, gait instability occurs.

(1) Peripheral neuropathy: peripheral neuritis caused by various causes.

(2) posterior spinal cord lesions: such as spinal cord paralysis, subacute combined degeneration.

(3) vestibular labyrinth lesions such as vestibular labyrinthine inflammation.

(4) cerebellar lesions: such as cerebellar hemorrhage, cerebellar infarction, cerebellar tumor, cerebellar inflammation.

(5) Pathological changes such as hemorrhage, ischemia, inflammation, and tumor in the frontal lobe, temporal lobe, parietal lobe, occipital lobe, and corpus callosum.

an examination

Related inspection

EEG examination, cranial CT examination, cranial nerve examination, nasal test

When checking the gait, observe the posture of the patient standing, walking, and the cooperation of the upper and lower limbs with the trunk. Let the patient walk straight forward, sideways, retreat, turn, and walk with the toes and heels. Different parts of the lesion can cause different types of abnormal gait.

1. Check brain CT or MRI to exclude cerebellar tumors, metastases, tuberculoma or abscesses and vascular diseases and cerebellar degeneration and atrophy.

2. Deep sensory ataxia such as localized lesions located in the peripheral nerve should be examined EMG, somatosensory evoked potential; such as in the posterior root lesion or posterior cord lesion should be examined EMG, evoked potential, MRI of the lesion, cerebrospinal fluid Check, or myelography. It is best to check brain CT or MRI when considering the thalamus or parietal lobe.

3. Cerebral ataxia should be checked for brain CT or MRI, EEG, etc.

4. Vestibular ataxia can be examined for electrical audiometry, auditory evoked potentials, and vestibular function tests.

Differential diagnosis

The identification of gait instability and 'half body': the former is the patient can walk, but the gait is special. The latter refers to the upper and lower extremity paralysis, can not move freely, accompanied by mouth and eye skew, mostly for stroke sequelae. The heel is alternated with the straight line of the toe, and the ataxia is unable to proceed due to the unstable balance. When you move forward, you will change direction, and the Atagrants will have difficulty moving.

Gait abnormality: 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.

Panic gait: After the start, the small step quickly moves forward, the foot does not leave the ground, wipes the ground, and the body leans forward, there is a tendency to fall to the ground, which is the typical gait of patients with tremor palsy, also known as Parkinson's disease.

gait: is a typical abnormal gait. When walking, the body swayed from side to side, showing a duck step. Common in neurological disorders, rickets, Kashin-Beck disease, progressive muscular dystrophy or bilateral congenital dislocation of the hip.

Sensory ataxia gait: 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 are both eyes It can be partially relieved when blinking, unstable or even unable to walk when closed eyes, often accompanied by sensory disturbance Romberg sign positive in subacute combined degenerative spinal cord.

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