Approach to the Patient with Gait Disturbance

2021 ◽  
Vol 41 (06) ◽  
pp. 717-730
Author(s):  
Christopher G. Tarolli ◽  
Karlo J. Lizarraga
Keyword(s):  
Neurological Disorders ◽  
Systematic Approach ◽  
Outpatient Visit ◽  
Chief Complaint ◽  
Algorithmic Approach ◽  
Daunting Task ◽  
Gait Dysfunction ◽  
Chief Complaints ◽  
Difficulty Walking

AbstractThe assessment of patients presenting with disorders of gait can be a daunting task for neurologists given the broad potential localization and differential diagnosis. However, gait disorders are extremely common in outpatient neurology, and all neurologists should be comfortable with the assessment, triage, and management of patients presenting with difficulty walking. Here, we aim to present a manageable framework for neurologists to approach the assessment of patients presenting with gait dysfunction. We suggest a chief complaint-based phenomenological characterization of gait, using components of the neurological history and examination to guide testing and treatment. We present the framework to mirror the outpatient visit with the patient, highlighting (1) important features of the gait history, including the most common gait-related chief complaints and common secondary (medical) causes of gait dysfunction; (2) gait physiology and a systematic approach to the gait examination allowing appropriate characterization of gait phenomenology; (3) an algorithmic approach to ancillary testing for patients with gait dysfunction based on historical and examination features; and (4) definitive and supportive therapies for the management of patients presenting with common neurological disorders of gait.

scholarly journals Spindle cell melanocytic lesions—part I: an approach to compound naevoidal pattern lesions with spindle cell morphology and Spitzoid pattern lesions

2010 ◽  
Vol 63 (4) ◽  
pp. 296-321 ◽  
Author(s):  
Shachar Sade ◽  
Ayman Al Habeeb ◽  
Danny Ghazarian
Keyword(s):  
Systematic Approach ◽  
Spindle Cell ◽  
Morphological Diversity ◽  
Biological Behaviour ◽  
Full Spectrum ◽  
Algorithmic Approach ◽  
Spindle Cells ◽  
Melanocytic Lesions ◽  
Biological Outcomes ◽  
Approach Problem

Melanocytic lesions show great morphological diversity in their architecture and the cytomorphological appearance of their composite cells. Whereas functional melanocytes reveal a dendritic cytomorphology and territorial isolation, lesional naevomelanocytes and melanoma cells typically show epithelioid, spindled or mixed cytomorphologies and a range of architectural arrangements. Spindling is common to melanocytic lesions, and may be either a characteristic feature or a divergent appearance. The presence of spindle cells may mask the melanocytic nature of a lesion, and is often disconcerting, either because of its infrequent appearance in a particular lesion or its interpretation as a dedifferentiated phenotype. Spindle cell melanocytic lesions follow the full spectrum of potential biological outcomes, and difficulty may be experienced judging the nature of a lesion because of a lack of consistently reliable features to predict biological behaviour. Over time, recognition of numerous histomorphological features that may portend a more aggressive lesion have been identified. However, the translation of these features into a diagnostic entity requires a gestalt approach. Although most spindle cell melanocytic lesions can reliably be resolved with this standard approach, problem areas do exist and cause no end of grief to the surgical pathologist or dermatopathologist. In this review, the authors present their algorithmic approach to spindle cell melanocytic lesions and discuss each entity in turn, in order to (1) model a systematic approach to such lesions, and (2) provide familiarity with those melanocytic lesions that either typically or occasionally display a spindled cytomorphology.

scholarly journals Neurological disorders in rural Africa - a systematic approach

2010 ◽  
Vol 27 (2) ◽  
Author(s):  
S Winkler ◽  
P Mosser ◽  
W Matuja ◽  
E Schmutzhard
Keyword(s):  
Neurological Disorders ◽  
Systematic Approach ◽  
Rural Africa

scholarly journals Determination of the Criminal Offense Elements in the Safety Rules Violation during Mining Operations

2019 ◽  
Vol 105 ◽  
pp. 02012 ◽  
Author(s):  
Olga Safargalieva ◽  
Oleg Sergeev ◽  
Yuriy Volgin ◽  
Marina Agienko
Keyword(s):  
Systematic Approach ◽  
Basic Element ◽  
Mining Operations ◽  
Criminal Offense ◽  
Official Position ◽  
Initial Stage ◽  
The Subject ◽  
Safety Rules

In the article, from the standpoint of a systematic approach, the forensic characterization of safety rules criminal violations during mining operations is analyzed. That is the basic element which determines the content and algorithm of uncovering of crimes, the investigation and trial of a criminal case. The subject (the identity of offender) is its central, basic element. It is noted that the element of subject (the identity of offender) is the most informative when investigating criminal violations of safety rules during mining operations. It is based on his study in the unity and interrelation of the following aspects: official position, social and psychological properties and personality traits and victimization behavior of the criminal offence victims and third parties. The situation of a crime (the second element of forensic characterization) is structured according to the circumstances that characterize pre-, criminal, and post-criminal state of outward things; three interrelated and interdependent are pointed out. The complex combination of the levels and edges of each selected elements of a cognizable object, due to the specifics of the crime in question, also determines the peculiarities of investigative actions and search activities at the initial stage of the investigation of safety rules criminal violations during mining operations. The article proposes recommendations to overcome the objective difficulties encountered in the investigation of criminal violations of safety rules during mining operations.

scholarly journals Characterization of Geriatric Dysphagia Diagnoses in Age-Based Cohorts

OTO Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. 2473974X2093954 ◽  
Author(s):  
Jeremy Applebaum ◽  
Emerson Lee ◽  
Aisha Harun ◽  
Ashley Davis ◽  
Alexander T. Hillel ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Chief Complaint ◽  
Esophageal Disease ◽  
Diagnostic Categories ◽  
Related Quality ◽  
Radiation Induced ◽  
Induced Changes

Objective An aging population requires increased focus on geriatric otolaryngology. Patients aged ≥65 years are not a homogenous population, and important physiologic differences have been documented among the young-old (65-74 years), middle-old (75-84), and old-old (≥85). We aim to analyze differences in dysphagia diagnoses and swallowing-related quality-of-life among these age subgroups. Study Design Retrospective chart review. Setting Tertiary care laryngology clinic. Subjects and Methods We identified chief complaint, diagnosis, and self-reported swallowing handicap (Eating Assessment Tool [EAT-10] score) of all new patients aged ≥65 years presenting to the Johns Hopkins Voice Center between April 2015 and March 2017. Dysphagia diagnoses were classified by physiologic etiology and anatomic source. Diagnostic categories and EAT-10 score were evaluated as functions of patient age and sex. Results Of 839 new patients aged ≥65 years, 109 (13.0%) reported a chief complaint of dysphagia and were included in this study. The most common dysphagia etiologies were neurologic and esophageal. Most common diagnoses were diverticula (15.6%), reflux (13.8%), and radiation induced (8.3%). Diverticula, cricopharyngeal hypertonicity, and radiation-induced changes were associated with higher EAT-10 score ( P < .001). Significant differences by sex were found in anatomic source of dysphagia, as men and women were more likely to present with oropharyngeal and esophageal disease, respectively ( P = .023). Dysphagia etiology and EAT-10 score were similar across age subgroups. Conclusion Important differences among dysphagia diagnosis and EAT-10 score exist among patients aged ≥65 years. Knowledge of these differences may inform diagnostic workup, management, and further investigations in geriatric otolaryngology.

Primary progressive multiple sclerosis developing in the context of young onset Parkinson’s disease

2012 ◽  
Vol 19 (1) ◽  
pp. 123-125 ◽  
Author(s):  
Anna Sadnicka ◽  
Una-Marie Sheerin ◽  
Charles Kaplan ◽  
Sophie Molloy ◽  
Paolo A Muraro
Keyword(s):  
Multiple Sclerosis ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Neurological Disorders ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Laboratory Findings ◽  
Young Onset ◽  
Primary Progressive

We report a patient with young onset Parkinson’s disease (PD) and a heterozygous point mutation in parkin (c.1000C>T; p.Arg334Cys). After 8 years he developed pyramidal signs and reinvestigation demonstrated MRI and laboratory findings supportive of a diagnosis of multiple sclerosis (MS) with a primary progressive (PP) clinical course. This is a previously un-described association of young onset PD with PPMS. Imaging clearly dates the occurrence of each disease as chronologically separate phenomena. There is not currently evidence for shared causation or pathogenesis between the two neurological disorders but we will follow with interest the emerging genetic characterization of parkin in both PD and MS.

scholarly journals Complete genome analysis identifies Tvärminne avian virus as a candidate new species within the genus Orthoreovirus

2014 ◽  
Vol 95 (4) ◽  
pp. 898-904 ◽  
Author(s):  
Eszter Dandár ◽  
Eili Huhtamo ◽  
Szilvia L. Farkas ◽  
Miklós Oldal ◽  
Ferenc Jakab ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Phylogenetic Analyses ◽  
Virus Species ◽  
Sea Lion ◽  
Avian Virus ◽  
Semiconductor Sequencing ◽  
Avian Origin ◽  
Complete Genome Analysis ◽  
Strain Genome

Orthoreoviruses have been associated with a variety of diseases in domesticated poultry and wild-living birds. In 2002, a reovirus strain named Tvärminne avian virus (TVAV), was identified in Finland in a crow showing neurological disorders. The objective of this study was the molecular characterization of this novel reovirus strain. Genome sequencing was performed by combining semiconductor sequencing and traditional capillary sequencing. Sequence and phylogenetic analyses showed that TVAV shares low nucleotide sequence identity with other reoviruses (range for each gene, 31–72 %) including strains belonging to the species Avian orthoreovirus. The most closely related reovirus strain was an isolate identified in Steller sea lion. Our data indicate that TVAV is a divergent reovirus of avian origin that may be the first representative of a distinct virus species within the genus Orthoreovirus.

scholarly journals Treatment of Class II Protrusion with Severe Crowding Using Indirect Miniscrew Anchorage

2007 ◽  
Vol 77 (6) ◽  
pp. 1109-1118 ◽  
Author(s):  
Nak-Chun Choi ◽  
Young-Chel Park ◽  
Han-Ah Lee ◽  
Kee-Joon Lee
Keyword(s):  
Class Ii ◽  
Chief Complaint ◽  
Nickel Titanium ◽  
Nonsurgical Treatment ◽  
Facial Profile ◽  
Skeletal Class ◽  
Skeletal Class Ii ◽  
Chief Complaints ◽  
Movement Mechanics

Abstract This report describes the nonsurgical treatment of a patient with skeletal Class II protrusion and severe crowding. A 20-year-old woman presented with the chief complaint of lip protrusion and crowding. To correct the Class II relationship, severe crowding, and lip protrusion, distal movement of the maxillary first molars using indirect miniscrew anchorage and nickel-titanium coil springs, along with extraction of the first premolars and maxillary second molars, was planned. After the distal molar movement phase was complete, the maxillary first molars had moved 8.0 mm to the distal, and the first premolars, which were splinted to the miniscrews, had moved 0.5 mm to the mesial. The results show that the distal molar movement mechanics were efficient and stable. After treatment, all of the patient's chief complaints were relieved and an esthetic facial profile was obtained.

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