Gait, bizarre [Hysterical gait]
A bizarre gait has no obvious organic cause; rather, it’s produced unconsciously by a person with a somatoform disorder (such as 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 any stressful period or event, such as the death of a loved one or loss of a job. Ask about associated symptoms, and explore any reports of frequent unexplained illnesses and multiple physician’s visits. Subtly try to determine if he’ll 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 any 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
In this rare somatoform disorder, a bizarre gait or paralysis may develop after severe stress and is not accompanied by other symptoms. The patient typically shows indifference toward his impairment.
Malingering
In this rare cause of bizarre gait, the patient may also complain of 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 he may exhibit peculiar contractures and arm or leg rigidity. His reputed sensory loss doesn’t conform to any known sensory dermatome. He may claim that he can’t stand (astasia) or walk (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 a bizarre gait has no organic cause, 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 bedridden patients, 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.
Patient counseling
Instruct the patient in the use of assistive devices as necessary. Review the components of a safe environment, such as establishing a clear path to the bathroom and using proper footwear.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Walking symptoms
Read excerpts from these other book chapters related to Walking symptoms:
Medical Books Excerpts
- ATAXIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- "In a Page: Signs and Symptoms" (2004)
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- "In A Page: Pediatric Signs and Symptoms" (2007)
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- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "A Pocket Manual of Differential Diagnosis" (1999)
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- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- "Field Guide to Bedside Diagnosis" (2007)
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- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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- "Nursing: Interpreting Signs and Symptoms" (2007)
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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Walking symptoms
» Next page:
Gait, propulsive [Festinating gait] (Professional Guide to Signs & Symptoms (Fifth Edition))
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