Gait, bizarre [Hysterical gait]

Gait, bizarre [Hysterical gait]: Excerpt from Handbook of Signs & Symptoms (Third Edition)

A bizarre gait has no obvious organic basis; rather, it’s produced unconsciously by a person with a somatoform disorder (hysterical neurosis) or consciously by a malingerer. The gait has no consistent pattern. It may mimic an organic impairment, but characteristically has a more theatrical or bizarre quality with key elements missing, such as a spastic gait without hip circumduction, or leg “paralysis” with normal reflexes and motor strength. Its manifestations may include wild gyrations, exaggerated stepping, leg dragging, or mimicking unusual walks such as that of a tightrope walker.

History and physical examination

If you suspect that the patient’s gait impairment has no organic cause, begin to investigate other possibilities. Ask the patient when he first developed the impairment and whether it coincided with a stressful period or event, such as the death of a loved one or loss of a job. Ask about associated symptoms, and explore reports of frequent unexplained illnesses and multiple physician’s visits. Subtly try to determine if the patient will gain anything from malingering, for instance, added attention or an insurance settlement.

Begin the physical examination by testing the patient’s reflexes and sensorimotor function, noting abnormal response patterns. To quickly check his reports of leg weakness or paralysis, perform a test for Hoover’s sign: Place the patient in the supine position and stand at his feet. Cradle a heel in each of your palms, and rest your hands on the table. Ask the patient to raise the affected leg. In true motor weakness, the heel of the other leg will press downward; in hysteria, this movement will be absent. As a further check, observe the patient for normal movements when he’s unaware of being watched.

Medical causes

Conversion disorder

Conversion disorder is a  rare somatoform disorder, in which a bizarre gait or paralysis may develop after severe stress and isn’t accompanied by other symptoms. The patient typically shows indifference toward his impairment.

Malingering

Malingering is a rare cause of bizarre gait, in which the patient may also complain of a headache and chest and back pain.

Somatization disorder

Bizarre gait is one of many possible somatic complaints. The patient may exhibit any combination of pseudoneurologic signs and symptoms — fainting, weakness, memory loss, dysphagia, visual problems (diplopia, vision loss, blurred vision), loss of voice, seizures, and bladder dysfunction. He may also report pain in the back, joints, and extremities (most commonly the legs) and complaints in almost any body system. For example, characteristic GI complaints include pain, bloating, nausea, and vomiting.

The patient’s reflexes and motor strength remain normal, but peculiar contractures and arm or leg rigidity may occur. His reputed sensory loss doesn’t conform to a known sensory dermatome. In some cases, he won’t stand or walk (astasia/abasia), remaining bedridden although still able to move his legs in bed.

Special considerations

A full neurologic workup may be necessary to completely rule out an organic cause of the patient’s abnormal gait. Remember, even though bizarre gait has no organic basis, it’s real to the patient (unless, of course, he’s malingering). Avoid expressing judgment on the patient’s actions or motives; you’ll need to be supportive and reinforce positive progress. Because muscle atrophy and bone demineralization can develop in a bedridden patient, encourage ambulation and resumption of normal activities. Consider a referral for psychiatric counseling as appropriate.

Pediatric pointers

Bizarre gait is rare in patients younger than age 8. More common in prepubescence, it usually results from conversion disorder.

Pictures

Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

More About Conversion Disorder

• Back to disease: Conversion Disorder: Introduction
• Next Book Extract About Conversion Disorder: Conversion disorder (Professional Guide to Diseases (Eighth Edition))
• More Book Extracts: All Online Books for Conversion Disorder

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

 » Next page: Conversion disorder (Professional Guide to Diseases (Eighth Edition))

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