Asymmetric freezing of gait in hemiparkinsonism-hemiatrophy

Abstract

A 62-year-old man presented with a 2-year history of dyskinesia and a 10-month history of gait difficulty. He had developed circumferential gait of the left leg at the age of 40 years. About 2 years later, he experienced slowness and stiffness with dystonic posturing of the left hand. When examined he had a mild left hemifacial and hand atrophy. There was marked rigidity, bradykinesia, and a 4 -6 Hz resting tremor in the left extremities. When he walked, he had circumduction of the left leg with ankle inversion and dystonic posturing of the left hand and foot as well as markedly decreased arm swing. His gait was frequently interrupted by unpredictable freezing, leading to immobilization. This freezing occurred most frequently when he turned to the left (see video clip). Brain MRI was normal. Hemiparkinsonismhemiatrophy was diagnosed.Freezing of gait (FOG) is a disabling gait disturbance associated with various types of parkinsonism.1 As a midline symptom affecting both legs, FOG is known to affect gait symmetrically. As suggested by Giladi, 2 however, our patient clearly demonstrated unilateral FOG, ipsilateral to the side of parkinsonism.

Hemiparkinsonism-hemiatrophy syndrome

“…29 A similar case associated with asymmetric freezing has been reported previously in a patient with HPHA. 30 Seven patients had brisk reflexes with extensor plantar response on the side of HA. The presence of pyramidal tract signs has been consistently noted in other reported cases of HPHA.…”

Asymmetry of arm-swing not related to handedness

“…A reduction in spasticity may improve symmetry of upper limb movements [26]. Reduced arm-swing, which can be asymmetrical, is also a typical feature of Parkinson's disease [27,28]. Wood and coworkers demonstrated that either unilateral or bilateral reduction of arm-swing is a predictor of falling in Parkinson patients [29].…”

Arm swing magnitude and asymmetry during gait in the early stages of Parkinson's disease

“…Although lower extremity asymmetry during gait has been well quantified in individuals with PD,4,14-16 the arm swing asymmetry during walking has only been described qualitatively. 1,6,17 For this reason, the present work focused on arm swing magnitude, and its side-to-side asymmetry, during gait in individuals with early PD. Based on previous descriptions of altered shoulder motion,4,7-9 and the asymmetric onset of motor symptoms,11,12 we hypothesized that arm swing in individuals with early PD would be decreased in amplitude and more asymmetric when compared to controls.…”