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Abnormalities observed during sitting and rising from a chair

Abnormalities observed during sitting and rising from a chair
Abnormalities Suggestions for differential diagnosis*
Sitting
Leaning sideways
  • Vertebral column deformities
  • Pisa syndrome: Either drug-induced (eg, dopamine receptor antagonists) or associated with neurodegeneration (AD, PD, atypical parkinsonism)
  • Pusher syndrome (unilateral thalamic stroke), trunk dystonias (including idiopathic Pisa syndrome)
Drifting backwards
  • PD, atypical parkinsonism (PSP)
  • Higher-level gait disorders
  • Trunk dystonia (opisthotonus), often drug-induced (dopamine receptor antagonists)
Forward dropping of the head (disproportionate antecollis)
  • MSA, ALS, myasthenia gravis, polymyositis, focal posterior cervical myositis
  • Drug-induced (dopamine receptor antagonists, amantadine)
Backward dropping of the head (retrocollis)
  • PSP, cervical dystonia, young-onset PD
  • Drug-induced (dopamine receptor antagonists)
Rising from a chair
Inappropriate motor strategies (eg, feet not brought under the body)
  • Higher-level gait disorders
Slow, requiring multiple attempts, or needing to push off with arms
  • Nonspecific
  • Proximal weakness, PD, higher-level gait disorders
Reckless rising ("rocket sign")
  • Early PSP
Shaking of the legs upon standing (negative orthostatic myoclonus)
  • Idiopathic orthostatic myoclonus, history of postanoxic encephalopathy, frontal vascular lesions, atypical parkinsonism, AD, normal pressure hydrocephalus
Legs wide apart while rising
  • Sensitive but nonspecific
  • Vestibular ataxia, sensory ataxia, cerebellar ataxia, atypical parkinsonism, chorea

AD: Alzheimer disease; ALS: amyotrophic lateral sclerosis; PD: Parkinson disease; PSP: progressive supranuclear palsy; MSA: multiple system atrophy.

* These suggestions are not comprehensive.
Reproduced with permission from: Nonnekes J, Goselink RJM, Růžička E, et al. Neurological disorders of gait, balance and posture: A sign-based approach. Nat Rev Neurol 2018; 14:183. Copyright © 2018 Springer Nature. https://www.nature.com/nrneurol/.
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