Neurological disorders of gait, balance and posture: a sign-based approach
Neurological disorders of gait, balance and posture: a sign-based approach
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DOI：
10.1038/nrneurol.2017.178
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发表时间：
2018-03-01
影响因子：
38.1
通讯作者：
Bloem, Bastiaan R.
中科院分区：
文献类型：
--
作者：
Nonnekes, Jorik;Goselink, Rianne J. M.;Bloem, Bastiaan R.
步态、平衡和姿势的神经障碍都是使人衰弱的常见疾病。充分认识这些所谓的轴向运动障碍是很重要的，因为它们可以提供有用的线索，潜在的病理在患者的临床诊断不确定，如那些在早期的神经系统疾病。医学教学计划通常以经典的临床表现为起点，并向学生展示一系列具有代表性的特征，这些特征共同表征了特定的轴向运动综合征。然而，在临床实践中，患者很少以这种方式出现在医生面前。特别是在疾病的早期阶段，患者可能只显示一个（或最多只有几个）步态，平衡或姿势的异常体征。重要的是，这些个体体征从来不是任何特定疾病的特征性体征，而是伴随着相关的鉴别诊断。在这个角度来看，我们提供了一个新的诊断方法，其中提出的迹象被视为重点鉴别诊断和定制搜索到潜在的神经系统综合征的起点。
Neurological disorders of gait, balance and posture are both debilitating and common. Adequate recognition of these so-called disorders of axial mobility is important as they can offer useful clues to the underlying pathology in patients with an uncertain clinical diagnosis, such as those early in the course of neurological disorders. Medical teaching programmes typically take classic clinical presentations as the starting point and present students with a representative constellation of features that jointly characterize a particular axial motor syndrome. However, patients rarely present in this way to a physician in clinical practice. Particularly in the early stages of a disease, patients might display just one (or at best only a few) abnormal signs of gait, balance or posture. Importantly, these individual signs are never pathognomonic for any specific disorder but rather come with an associated differential diagnosis. In this Perspective, we offer a new diagnostic approach in which the presenting signs are taken as the starting point for a focused differential diagnosis and a tailored search into the underlying neurological syndrome.