Force Scaling

Hemiplegie or paraplegic gait

Cerebellar ataxia

MRI: Lesions in thalamus, putamen, midbrain

MRI: Atrophy of midbrain

Parkinsonian gait

MRI: Stenosis of lumbosacral canal and foramina

CT or MRI: Brain or spinal cord lesions

MRI: Brain stem and cerebellar lesions

Large volume CSF tap

Slowed NCV

Decreased sensory action potential

Abnormal ENG BAER

VDRL

Vitamin B,2

CSF: protein, glucose

VDRL

Glucose

Glucose

EMG: Myopathic changes

CT or MRI: Hypointense putamen

NCV: slowed conduction EMG: Denervation

SSEP N/A

RA factor

Thyroid studies Muscle biopsy Glucose Nerve biopsy

Vitamin B12

Thyroid studies

Toxicology screen

CSF: IgG, cells

Anti-Purkinje cell Ab

Memory Memory Memory

Thyroid studies N/A

Memory N/A/

Vascular studies

Slit-lamp examination

Perimetry

Tensilon test

Choreic gait

Dystonic gait

ADAPTATION

Cautious Dementia

Attention and balance

MRI: Putaminal lesions; atrophy of striatum

CT or MRI: Putaminal or thalamic lesions

CT or MRI: Cortical atrophy; other cortical lesions

CT or MRI: Cortical atrophy

EEG: Slowing

Post-fall N/A N/A N/A Anxiety

Psychogenic N/A N/A N/A Hysterical traits

Suggestibility Depression

NCV, Nerve conduction velocity; VER visual evoked responses VDRL, Venereal Disease Research Laboratories; CSF, cerebrospinal fluid; HIV, human immunodeficiency virus; ACh, acetylcholine; EMG, electromyography; MRI, magnetic resonance imaging; RA factor, rheumatoid arthritis factor; ESR, erythrocyte sedimentation; CK, creatine kinase; ANA, antinuclear antibody; WBC, white blood cells; SSEP, somatosensory evoked potentials; HD, Huntington's disease; EEG, electroencephalography; BAER, brain stem auditory evoked response; Ab, antibody; MSA, multiple system atrophy; ENG, electronystagmography; CT, computed tomography; N/A, not applieable.

Ceruloplasmin HD genetic test Acanthocytes Anticardiolipin Ab Ceruloplasmin Liver biopsy

Dementia

Metabolic screen Drug screen N/A N/A

Memorv Distractibility Cognitive impairment Inattention

Slit-lamp examination

TABLE 18-3 -- SELECTED ETIOLOGIES ASSOCIAT

ED WITH DISORDERS OF GAIT AND BALANCE

Etiological Category

Specific Etiologies

Chapter

STRUCTURAL DISORDERS

Developmental structural disorders

Chiari malformation with hydrocephalus

2S

Normal pressure hydrocephalus

HEREDITARY AND DEGENERATIVE DISORDERS

Storage diseases: Lipidoses, glycogen disorders and leukoencephalopathies

Metachromatic leukodystrophy

30

Organic amino acidopathies, mitochondrial enzyme defects and other metabolic

GTP cyclohydrolase mutations (dopa-responsive dystonia)

31

errors

Chromosomal abnormalities and neurocutaneous disorders

Neurofibromatosis type II

32

Degenerative dementias

Alzheimer's disease

33

Movement disorders

Huntington's disease

34

Parkinson's disease

Multiple system atrophy

Ataxias

Autosomal dominant spinocerebellar ataxias

35

Episodic ataxia

Degenerative motor sensory, and autonomic disorders

Amyotrophic lateral sclerosis

36

Duchenne muscular dystrophy

Hereditary sensory motor neuropathies

Myotonic dystrophy

Inherited muscle, neuromuscular, and neuronal disorders

Congenital myopathies

37

ACQUIRED METABOLIC AND NUTRITIONAL DISORDERS

Endogenous metabolic disorders

Thyroid myopathy

3S

Nutritional deficiencies and syndromes associated with alcoholism

Thiamine deficiency (Wernickes encephalopathy), vitamin B 12

40

deficiency

INFECTIOUS DISORDERS

Viral infections

HTLV-I infection, labyrinthitis

41

Nonviral infections

Syphilis

42

Transmissible spongiform encephalopathy

Creutzfeldt-Jakob disease

43

HIV and AIDS

Vacuolar myelopathy

44

NEUROVASCULAR DISORDERS

Binswanger's disease, infarction, hemorrhage

45

NEOPLASTIC DISORDERS

Primary neurological tumors

Butterfly glioma

46

Metastatic neoplasms and paraneoplastic syndromes

Paraneoplastic cerebellar degeneration

47

Any metastasis to brain, brain stem or spinal cord

DEMYELINATING DISORDERS

Demyelinating disorders of the central nervous system

Multiple sclerosis

4S

Demyelinating disorders of the peripheral nervous system

Guillain-Barre syndrome

49

AUTOIMMUNE AND INFLAMMATORY DISORDERS

Myasthenia gravis

50

Polymyositis

Inclusion body myositis

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