Gait disturbance

Multiple sulfatase deficiency (MSD). The clinical presentation of MSD includes features of MLD and the MPS, with the features that resemble MLD, such as gait disturbances, psychomotor retardation and polyneuropathy predominating. MPS-like features, such as facial coarsening, hepatosplenomegaly and joint stiffness, are present to a milder and variable extent. A reduction in the activity of all sulfatases is the key diagnostic abnormality. Von Figura and associates have demonstrated that catalytic activity of all sulfatases requires a post-translational modification in which a cysteine residue (cysteine 69 in arylsulfatase A) is oxidized to an aldehyde. It is this modification that is defective in MSD [5]. 

Human 5 yr 190 (peripheral neuropathy, gait disturbance, decreased MCV) Wang et al. 1986... 

Parkinson s disease (shaking palsy) and its syndromal forms are caused by a degeneration of nigrostriatal dopamine neurons. The resulting striatal dopamine deficiency leads to overactivity of choUnergic intemeurons and imbalance of striopallidal output pathways, manifested by poverty of movement (akinesia), muscle stiffness (rigidity), tremor at rest, postural instability, and gait disturbance. 

The LCso for rats was 8000 ppm for a 4-hour exposure. The LCso for mice was 2 040 ppm for a 7-hour exposure the effect was central nervous system depression. A 20-minute exposure to concentrations ranging from 2000 to 8000 ppm caused neurobehav-ioral effects in mice including gait disturbances, impaired psychomotor coordination, decreased arousal and rearing, and changes in posture. ... 

CNS effects Psychomotor slowing, difficulty with concentration, and speech or language problems somnolence or fatigue and coordination abnormalities, including ataxia and gait disturbances. 

CNS disorders CNS adverse reactions including decreased mental status, gait disturbance, and dizziness have been observed, particularly in patients receiving doses greater than 250 mcg/m /day. Most of these abnormalities were mild and reversible within a few days upon dose reduction or discontinuation of therapy. Exercise caution in patients with seizure disorders and compromised CNS function. Cardiac disease Use with caution in patients with pre-existing cardiac disease, including symptoms of ischemia, CHF, or arrhythmia. 

Interferon gamma-1 b may exacerbate preexisting CNS disturbances, including decreased mental status, gait disturbance, and dizziness, as well as cardiacdisorders. 

Sedative-hypnotics Excessive sedation, delirium, gait disturbances... 

Carbamazepine toxicity is manifested by drowsiness, nausea and vomiting, gait disturbance, nystagmus, confusion, neuromuscular excitability, and seizures (Menkes, 1999). Overdose with CBZ can be lethal (Arana et ah, 1986). In a retrospective study of 307 intoxicated patients, 41 (13%) had a fatal outcome (Schmidt and Schmitz-Buhl, 1995). Doses exceeding 24 g were important indicators of fatality. The management of CBZ overdose is primarily supportive, to prevent potential atrioventricular (AV) block (Arana et ah, 1986), possible respiratory depression (Schmidt and Schmitz-Buhl, 1995), stupor, and coma. 

Very rare disorders include juvenile metachromatic leukodystrophy, adrenoleucodystrophy, Wilson s disease These conditions are associated with movement disorders, particularly gait disturbance. It is important to attempt to distinguish between primary and secondary (antipsychotic related) movement disorders These conditions are characterized by a progressive loss of cognitive skills (in contrast to the more relative decline seen in schizophrenia and other developmental disorders, where a loss of previously learned skill is unusual)... 

The clinical manifestations are axonal degeneration, gait disturbances, ophthalmoplegia, hyporeflexia and necrotizing myopathy. 

After 4 months, he developed numbness and paresis of the legs and hyperalgesia at dermatomes T3 and T4. After 10 months he had marked disturbance of proprioception combined with spinal ataxia and an increasing loss of motor bladder control. There was an intraspinal epidural lipoma in the dorsal part of the spine from Tl-10. The fat was removed surgically and within 4 weeks his gait disturbance and proprioception improved, the sensory deficit abated, and the bladder disorder disappeared completely. 

Toxicity On exposure, chlorobenzenes are known to cause irritation to the skin, conjunctiva, and mucous membranes of upper respiratory tract. Prolonged and repeated exposure with liquid chlorobenzene causes skin burns. Acute exposure to chlorobenzenes causes drowsiness, incoordination, gait disturbances, and unconsciousness. In view of this, workers are advised to handle the chemical with proper protective clothing and under qualified supervision.122123... 

A 51-year-old woman developed toxic serum concentrations of clozapine and N-desmethylclozapine (norclozapine) during an acute urinary tract infection and had a short period of aphasia and akinesia, followed by incoherence of speech and a gait disturbance. 

A 39-year-old man presented with a gait disturbance confusion, hyperthermia (38.2 C), and hyperhidrosis after massive ingestion of a formulation containing diphenhydramine. With intensive support, including bromocriptine, he recovered within 12 days. The estimated dose of diphenhydramine was 40 mg x 60 tablets, and each tablet included 26 mg of diprophylline, a xanthine derivative. 

Nagano T, Mizngnchi M, Kurihara E, Miznno Y, Tamagawa K, Komiya K. [A case of acnte disseminated encephalomyehtis with convulsion, gait disturbance, facial palsy and multifocal CT lesions.] No To Hattatsu 1988 20(4) 325-9. 

A 6-year-old girl and a 5-year-old boy had drowsiness, paresthesia, and gait disturbance 14 and 17 days respectively after immunization with Japanese encephalitis vaccine. Treatment with prednisolone improved the clinical findings (8,9). 

---