Neurology Main神经内科 121-130-课件.ppt

Neurology Main 121-130 Q 121A 54-year-old man comes to the office due to recurrent falls. During ambulation, the patient prominently flexes his right hip and knee and the right foot slaps to the floor with each step. Romberg sign is absent. Which of the following is the most likely cause of this gait abnormality?A. Basal ganglia lesion B. Cerebellar dysfunction C. Common peroneal neuropathy D. Corticospinal tract lesionE. Damage to frontal lobe cortico-cortical white matter tracts F. Sensory neuropathy A 121Correct answer:CThis patient has a high-stepping or steppage11 gait due to right foot drop. Foot drop is due to weakness in foot dorsiflexion. To compensate for this, patients must flex the hip and knee to raise the foot and avoid dragging the toe with each step.Steppage gait is most commonly caused by L5 radiculopathy or neuropathy of the common peroneal nerve. L5 radiculopathy is typified by back pain radiating to the foot, often with weakness of foot inversion and plantar flexion. Peroneal neuropathy is due to compression of the nerve at the lateral aspect of the fibula (egf due to prolonged crossing of the legs or squatting) and is associated with paresthesias and sensory loss over the dorsum of the foot but normal foot inversion and plantar flexion. The diagnosis can be clarified with electromyography and nerve conduction studies.(Choice A) Lesions in the basal ganglia can present with a slow shuffling gait as seen in patie门ts with Parkinsons disease.(Choice B) Cerebellar ataxia can result from lesions of the vermis (truncal ataxia) or the cerebellar hemispheres (limb ataxia). Features of cerebellsir include staggering and swaying from side to side, impaired tandem gait and titubation (truncal tremor).(Choice D) Pyramidal tract or corticospinal tract (CST) lesions can cause spastic ataxia. The gait appears stiff or rigid with circumduction (the spastic leg is abducted and advanced while in extension and internal rotation) and plantar flexion of the affected