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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 82

Diagnostic gait pattern in a treatable neuromuscular disorder


Pediatric Neurology Unit, Department of Pediatrics, Advanced Paediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Submission16-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Lokesh Saini
Pediatric Neurology Unit, Department of Pediatrics, Advanced Paediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2110_19

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How to cite this article:
Singanamalla B, Saini L. Diagnostic gait pattern in a treatable neuromuscular disorder. Indian J Med Res 2020;152, Suppl S1:82

How to cite this URL:
Singanamalla B, Saini L. Diagnostic gait pattern in a treatable neuromuscular disorder. Indian J Med Res [serial online] 2020 [cited 2021 Jul 29];152, Suppl S1:82. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/82/316706

The child's assent and parents' consent obtained to publish clinical information and image.


A eight yr old pre-morbid female child presented to the Pediatric Neurology unit, Postgraduate Institute of Medical Education & Research, Chandigarh, India, in June 2019, with progressive difficulty in running and walking since the last six months. On examination, she had modified Gowers' sign, proximal weakness of the upper limbs in addition to proximal weakness of the lower limbs. She had a characteristic gait pattern which gave us a hint for the probable diagnosis (Video 1). Her muscle enzymes were normal and anti-AChR (acetylcholine receptor) antibodies were 100 times elevated. Repetitive nerve stimulation test showed decremental response over proximal muscles at 3 Hz at baseline [Figure 1]. She responded to oral steroids and pyridostigmine dramatically (Video 2).
Figure 1: Repetitive nerve stimulation test of the right deltoid muscle done at baseline at 3 Hz showing characteristic decremental response up to 17 per cent (arrows) and repair occurring after seventh wave suggestive of post-synaptic neurotransmission defect.

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[Additional file 1]

[Additional file 2]

Children with limb girdle myasthenia have a characteristic gait resembling a 'slow catwalk' to prevent themselves from falling. Hence, like limb girdle myasthenia should be kept in mind on similar presentations as it can masquerade as muscular dystrophies.

Acknowledgment: Authors thank the parents of the patient for videos and adding to the literature.

Conflicts of Interest: None.


    Figures

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