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Functional gait disorder — SCE Neurology MCQ

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HardFunctional, Rehabilitation and DVLAFunctional gait disorderSCE Neurology

A dramatic buckling gait improves with distraction; bed strength is normal, reflexes are symmetrical and imaging and nerve conduction are unrevealing. Which positive diagnosis best fits?

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Correct answer: B — Functional gait disorder, with these neuroanatomical findings, in this presentation

The best answer is “Functional gait disorder, with these neuroanatomical findings, in this presentation”. Internal inconsistency and improvement with distraction are positive signs of functional gait disorder, not merely absence of structural disease. “Lumbar canal stenosis with fixed neurogenic claudication” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Length-dependent polyneuropathy with sensory ataxia” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Cerebellar degeneration with consistent truncal ataxia” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Orthostatic hypotension causing reproducible presyncope” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here.

Reference: JNNP practical review of functional neurological disorder: https://jnnp.bmj.com/content/92/1/53