The medical history (history of the patient) represents an important component in the diagnosis of gait disorder. Family history Are there any people in your family with neurologic disorders? Are there any hereditary diseases in your family? Social anamnesis Current medical history/systemic medical history (somatic and psychological complaints). How long has the gait disorder been … Gait Disorders: Medical History
Eyes and ocular appendages (H00-H59). Visual acuity reduction Endocrine, nutritional, and metabolic diseases (E00-E90). Hashimoto’s thyroiditis – autoimmune disease leading to chronic thyroiditis. Hyponatremia (sodium deficiency). Hypothyroidism (hypothyroidism) Vitamin B12 deficiency Cardiovascular system (I00-I99) Arterial circulatory disorder (peripheral arterial disease, pAVD; intermittent claudication → intermittent claudication). Infectious and parasitic diseases (A00-B99). Neurosyphilis (Tabes dorsalis) – … Gait Disorders: Or something else? Differential Diagnosis
Classification of ataxias (gait disorders) of adulthood [see S1 guideline below]. Hereditary (inherited) ataxias. Autosomal recessive ataxias Friedreich’s ataxia (FRDA) Other autosomal recessive ataxias. Autosomal dominant ataxias Spinocerebellar ataxias (SCA). Episodic ataxias (EA) X-linked inherited ataxias Fragile X-associated tremor ataxia syndrome (FXTAS). Sporadic degenerative ataxias Multisystem atrophy, cerebellar type (MSA-C). Sporadic adult-onset ataxia of unclear … Gait Disorders: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes. Gait (fluid, limping) or examination of gait and balance: Romberg standing test (synonyms: Romberg test; Romberg test) – … Gait Disorders: Examination
2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Small blood count Differential blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Thyroid parameters – TSH; thyroid autoantibodies. Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase … Gait Disorders: Lab Test
Therapy target Relief of symptoms Therapy recommendations Episodic ataxia type 2 (EA2): fampirdine (4-aminopyridine; drug from the group of reversible potassium channel blockers) to reduce the frequency of ataxias; the same applies to acetazolamide and carbamazepine Ataxias of mixed etiology: riluzole (drug belongs to the benzothiazole group)100 mg/d. Spinocerebellar ataxias (SCA) and Friedreich’s ataxia: riluzole … Gait Disorders: Drug Therapy
Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnostic clarification. Computed tomography of the skull (cranial CT, cranial CT or cCT)/spine – if neurological cause such as apoplexy (stroke), disc prolapse (herniated disc), etc. is suspected. Magnetic resonance imaging of the skull … Gait Disorders: Diagnostic Tests
Gait disorders can be characterized as follows: Anxious gait (e.g., due to fear of falling). Antalgic – limping gait Ataxic/ataxia – uncoordinated gait (may occur even if there is no paresis (paralysis), i.e. with normal muscle strength). Dyskinetic – gait with over-movements. Hypokinetic – small-step, slowed gait. Paretic – asymmetrical gait Psychogenic – with different, … Gait Disorders: Symptoms, Complaints, Signs
Therapy for gait disorders depends on the cause. General measures Nicotine restriction (refraining from tobacco use). Alcohol abstinence (complete renunciation of alcohol). Review of permanent medication due topossible effect on the existing disease. Regular check-ups Regular medical checkups Nutritional medicine Nutritional counseling based on nutritional analysis Nutritional recommendations according to a mixed diet taking into … Gait Disorders: Therapy
