Abstract Details

Title Psychogenic Gait Disorder Complicating Recovery after Concussion: A Case Series

Topic Child Neurology and Developmental Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-063

Objective This report is an initial description of three cases of psychogenic gait complicating recovery after concussion. The author hopes to raise awareness of psychogenic gait as a potential factor in persistent post-concussive syndrome among clinicians, particularly non-neurologists, seeing concussion patients.

Background Gait impairments are common after concussion. “Dizziness” is known to be associated with prolonged recovery after concussion. Typically, these symptoms have been considered to be of vestibular origin. However, whether or not there are non-vestibular etiologies of gait instability that complicate concussion recovery has been less fully explored. Psychogenic gait disorders occur in up to ten percent of adults with psychogenic movement disorders. The frequency of psychogenic gait disorders in adolescents has not been reported.

Design/Methods A chart review was performed of all of the patients seen in the first 6 months of a newly established, weekly, neurologist driven, Pediatric TBI clinic. The focus of this clinic is on concussion with prolonged recovery and non-sports concussion.

Results Of forty four patients with traumatic brain injury, three were found to have developed a classic psychogenic gait. All three were adolescents at the time of diagnosis. Included were; one patient who was unable to walk but with encouragement was able to run, another with astasia-abasia, and a third with sudden buckling of the knees. All three patients demonstrated marked improvement with encouragement, distraction,or more challenging gaits. For two patients, gait dysfunction had been intractable to vestibular therapy for several weeks prior to accurate diagnosis. In only one case was there a pre-existing psychiatric diagnosis. Recognition of psychogenic gait led to modification of physical therapy and/or mental health intervention and eventual resolution for all three patients.

Conclusions

Psychogenic gait disorders can complicate concussion recovery in adolescents. Accurate diagnosis and appropriate treatment lead to improvement in the patients reported in this series.

Authors/Disclosures
Scott I. Otallah, MD (Wake Forest) PRESENTER	Dr. Otallah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Merck.

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