Walking with Difficulty

Walking with Difficulty

1. Skull Anatomy

   • Norma Basalis externa
   • Norma Basalis interna

2. Muscle weakness

   • Distinguishing true muscle weakness from motor impairment not due to loss of muscle power​
     • through
       • History taking
       • Physical Examination
   • Localizing the site of lesion
   • Determining the cause of the lesion
   • causes include inflammatory disorders, endocrinopathies, metabolic myopathies, drugs and toxins, infections, and the various causes of rhabdomyolysis

3. GAIT​

   • HEMIPLEGIC GAIT (SPASTIC GAIT)
     • leg is stiff, without flexion at knee and ankle, and with each step is rotated away from the body, then towards it, forming a semicircle.
   • PARKINSONIAN GAIT​
     • exhibited by patients suffering from Parkinson's disease
   • ATAXIA GAIT​
     • presence of abnormal, uncoordinated movements.
       • cerebellar disturbances and can be seen in patients with longstanding alcohol dependency​
   • Diplegic Gait(Scissors gait)
     • form of gait abnormality primarily associated with spastic cerebral palsy
   • MYOPATHIC GAIT (WADDLING GAIT).​
     • due to the weakness of the proximal muscles of the pelvic girdle.
   • NEUROPATHIC GAIT (STEPPAGE GAIT ):​
     • foot drop due to loss of dorsiflexion.
       • due to damage to the deep peroneal nerve

4. RADIOLOGICAL INVESTIGATION of Syringomyelia

5. CHIARI I MALFORMATION

   • Congenital hindbrain abnormality​
     • Downward displacement of medulla and cerebellar tonsils​
     • causes or leads to
       • Syringomyelia
         • development of a fluid-filled cyst (syrinx) within the spinal cord. Over time, the cyst may enlarge, damaging the spinal cord.​
           • acquired by (other causes)
             • Complication of trauma
             • meningitis
             • hemorrhage,
             • tumor
             • arachnoiditis
             • Clinical presentation
               • Loss of pain, temperature & crude touch sensation​
                 • patient comes with burned hands
                 • Lesion affecting the lateral spinothalamic tract
               • Muscle weakness and wasting (atrophy)
               • Loss of reflexes​
               • Charcot Joint ​
           • Monitoring
             • periodic MRI and neurological exams
         • Surgery
           • Treating Chiari malformation.
           • Draining the syrinx.
           • Removing the obstruction.
           • Correcting the abnormality.

6. Tracts

   • Upper motor neuron lesion in his lower limb
     • Spastic gait
   • Lower motor neuron lesion in his upper limb
     • hyperflexia

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