EpistemisMagnetic march
Specialty: Neurology.
Why it occurs
- Normal pressure hydrocephalus (Hakim-Adams syndrome, characterized by the triad of magnetic gait, urinary incontinence and cognitive impairment)
- Binswanger's disease (severe subcortical vascular leukoencephalopathy due to arteriosclerosis)
- Lewy body dementia (with prominent parkinsonism predominantly in the lower limbs)
- Giant tumors of the frontal midline (such as meningiomas of the olfactory groove that involve the bilateral supplementary motor cortex)
- Advanced Parkinson's disease with predominant freezing of gait phenomenon
Initial workup
Brain magnetic resonance imaging to assess dilation of the lateral ventricles with relative sparing of the convexity sulci (Evans index > 0.3) and areas of leukoaraiosis; high-volume CSF evacuation test (lumbar puncture evacuating 30-40 ml of CSF with assessment of speed and quality of gait before and after the procedure) to predict the success of a ventriculo-peritoneal shunt.
red flags
Rapidly progressive magnetic gait (weeks) accompanied by refractory morning headache, shotgun vomiting, lethargy or bilateral papilledema in the fundus, indicating decompensated intracranial hypertension due to an expansive process or acute obstructive hydrocephalus.
Standard management
- Ventriculoperitoneal shunt placement — DVP, definitive treatment of normal pressure hydrocephalus
- Levodopa/Carbidopa — to relieve the rigid-akinetic component if Parkinson's disease coexists
- Active prevention of falls through walkers and adaptations at home.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3