tailieunhanh - Differential Diagnosis in Neurology and Neurosurgery - part 9

Bệnh nhân bị ảnh hưởng bởi bại não diplegic có đôi chân nhỏ và ngắn trái ngược với ngực bình thường phát triển, vai và cánh tay. Diplegia co cứng, co thắt nghiêm trọng ở chân, co cứng tối thiểu trong vòng tay, và thâm hụt ít hoặc không nói hoặc nuốt, trong khi ở liệt nửa người tăng gấp đôi | Types of Stance and Gait 267 Spastic diplegic gait Spastic-ataxic gait Basal ganglia gaits Marche à petits pas gait with little steps Parkinsonian gait Festinating gait Choreiform gait Spastic-athetoid gait Equinovarus dystonic gait Patients affected by diplegic cerebral palsy have small and short legs in contrast to normally developed chest shoulders and arms. In spastic diplegia there is severe spasticity in the legs minimal spasticity in the arms and little or no deficit in speaking or swallowing whereas in double hemiplegia there is pseudobulbar palsy and more arm weakness than leg weakness If in addition to spasticity the disease impairs the dorsal columns or cerebellum as in spinocerebellar degeneration or multiple sclerosis patients have a wider-based unsteady gait and take irregular steps Elderly patients with small vessel disease due to arteriosclerosis appearing as multiple lacunar infarcts in the basal ganglia develop a characteristic gait with shuffling short steps and are unable to lift the feet from the ground. Progress in walking ceases if the patient tries to speak they are unable to walk and talk or chew gum at the same time Patients with degeneration of the substantia nigra or neuroleptic medication toxicity rise and walk slowly with short steps lack any arm swing turn en bloc like a statue rotating on a pedestal and have a tremor when at rest which disappears during intentional movement When patients are pushed after prior warning they move forward or backward with tiny steps of increasing speed and decreasing length as if chasing the center of gravity and they may fall over When patients with Huntington s or Sydenham s chorea walk the play of finger and arm movements increases or may even appear clearly for the first time. Random missteps mar the evenness of the strides as the choreiform twitches supervene A combination of athetosis and moderate spastic diplegia or double hemiplegia secondary to perinatal hypoxic damage of the basal ganglia and