Stamping gait is observed when deep sensitivity is disturbed against the background of lesions of the central and peripheral nervous system: injuries, tumors, hemorrhages in the brain and spinal cord, inflammatory and non-inflammatory lesions of the spinal cord, polyneuropathies of various etiologies, multiple sclerosis, Friedreich's ataxia, Guillain-Barré syndrome. The etiology of the disorder is established on the basis of an anamnesis, data from a general and neurological examination, imaging and laboratory techniques. Vitamins, nootropics, cholinesterase agents, exercise therapy, physiotherapy, and surgical methods are used in the treatment.
A change in gait develops as a result of damage to any part of the proprioceptive system responsible for deep sensitivity: receptors in muscles, tendons and skin, peripheral nerves, posterior columns of the spinal cord and brain, ventrolateral thalamic nucleus, parietal lobe, precentral gyrus. Due to the inability to feel his own body, the patient makes exaggerated, too strong movements under careful visual control.
The patient excessively flexes and unbends the legs in the joints, spreads them widely at each step, with force lowers the limb to the floor, hitting the heels on the surface. Due to the inability to feel contact with the floor, it seems to a person that he “falls through”, walks “as if on cotton wool”. When moving, the patient constantly looks at his feet. In the absence of visual control, gait disturbances increase so much that walking becomes impossible.
A stamping gait is formed with lesions of the corresponding areas of the cortex, thalamus, medulla oblongata:
Symptoms gradually increase, the list of manifestations expands. The rate of progression depends on the rate of tumor growth, and is higher in malignant neoplasia.
The clinical picture of ischemic or hemorrhagic stroke is formed suddenly. Cerebral and focal symptoms are revealed. Headache, vomiting are combined with disorders of consciousness. Hemiparesis is often observed, manifested by a distortion of the face, muscle weakness, impaired sensitivity of half of the body. Aphasia, dysphagia, hearing disorders, reduced criticism are possible. The severity of stamping gait, other residual effects in the long term varies.
Stamping gait is the result of severe head injury with fractures of the bones of the vault and base of the skull, crush injuries, brain contusions, intracerebral, epidural, subdural hematomas. Sometimes it is formed after surgical interventions on the corresponding structures with tumors, abscesses, vascular lesions, and other pathologies.
stamping gait
Symptoms depend on the location of the tumor. With extramedullary neoplasia, radicular symptoms initially predominate, which may resemble manifestations of sciatica in patients with degenerative lesions of the spinal column. With an intramedullary location, a spinal cord neoplasm manifests as dissociated sensory disorders. In the future, there is an increase in motor and sensory disorders.
Stamping gait is a possible, but not obligatory symptom; it is found when the hind horns are affected against the background of the relative safety of other structures. With further spread of neoplasia, it is supplemented by paresis, paralysis.
In the acute period of hemorrhagic or ischemic spinal stroke, depending on the location of the pathological focus, tetra- or paraplegia develops, violations of all types of sensitivity. Subsequently, residual effects of varying severity are observed, one of the variants of which is a stamping gait.
Neurological disorders can occur at the time of injury (with spinal cord contusion, compression or damage to spinal structures by displaced vertebrae, vertebral fragments) or appear after a while (during the formation of a hematoma, secondary displacement of bone and cartilage structures). The clinical picture is variable, determined by the localization, prevalence of the lesion.
Stamping gait can be a sign of the following diseases:
Stamping gait accompanies various types of polyneuropathy. Symmetric sensory disturbances are typical, gradually spreading from the distal to the proximal. Initially, positive sensory disorders predominate: paresthesia, hyperesthesia. Then hypesthesia develops, with the defeat of thick myelinated fibers, changes in gait are formed. The symptom is detected in alcoholic, metabolic, infectious-toxic, autoimmune polyneuropathies, including Guillain-Barré syndrome.
There are a number of diseases with sensitive ataxia due to the simultaneous involvement of the peripheral and central nervous system. An example of such a pathology is multiple sclerosis, in which the gait is both shaky and stamping. Pathology is characterized by a polymorphic clinical picture with pyramidal, cerebellar symptoms, and movement disorders. In most cases, a relapsing course is observed.
With Friedreich's ataxia, as in the previous case, the gait has a shaky or stamping character. Changes in the walking pattern are detected in the early stages, then neurological symptoms progress, paresis, atrophy of the lower extremities are detected. In the future, the upper limbs are involved in the process. Bone deformities are formed. Possible cardiomyopathy, atrophy of the optic nerves, dementia.
Diagnostic measures are carried out by a neurologist. The specialist finds out when the stamping gait appeared, what symptoms it was accompanied by, what injuries or diseases preceded the development of this disorder. During the examination, a characteristic pattern of walking is revealed, instability in the Romberg position, which increases when the eyes are closed. In a position with arms extended forward, pseudoathetosis is possible.
The results of coordinating tests are unsatisfactory. The tone of the muscles of the lower extremities is reduced. Other focal and cerebral symptoms may be present. The additional examination plan includes the following procedures:
Neurological rehabilitation
In the treatment of diseases accompanied by a stamped gait, medicines of the following groups are used:
For tumors, chemotherapy and radiation therapy may be indicated. Drug treatment is supplemented with physiotherapy, massage, acupuncture. Patients are trained in physiotherapy exercises aimed at improving coordination of movements.
Patients with stamping gait undergo the following surgical interventions: