Parmak ucunda yürüme ile başvuran çocuklar: ne zaman endişe duyulmalı?

Year 2024, Volume: 49 Issue: 3, 736 - 743, 30.09.2024

Canan Üstün , Deniz Menderes , Pınar Özbudak , Elif Perihan Öncel , Bahadır Konuşkan

https://doi.org/10.17826/cumj.1491211

Abstract

Amaç: Bu çalışmanın amacı parmak ucunda yürüme (PUY) ile başvuran çocukları değerlendirmek ve altta yatan tıbbi durumların potansiyel göstergelerini belirlemektir. Gereç ve Yöntem: Çocuk Nöroloji Polikliniği'ne yürüme bozukluğu nedeniyle başvuran 248 hastadan 1-17 yaş arası 90'ında parmak ucunda yürüme tespit edildi. Sistemik nörolojik hastalıkları ve yaygın gelişimsel bozuklukları (YGB) olanlar dışlandıktan sonra, çalışmaya 47 hasta dahil edildi.
Bulgular: Hastaların 19'u kız (%40,5) ve 28'i erkekti (%59,5). Hastaların ortalama yaşı 4,9 yıldı (SD ± 3,53). PUY etiyolojisi değerlendirildiğinde, 30 hastada (%63,8) idiyopatik parmak ucunda yürüme (IPUY), 8 hastada (%17) serebral palsi (SP), 6 hastada (%12,7) Aşil tendon kısalığı (ATK), 2 hastada (%4,2) herediter spastik parapleji (HSP) ve 1 hastada (%2,1) siringomiyeli saptandı. Hastaların 17'sine (%36,1) görüntüleme yapılmazken, 13'üne (%27,6) kraniyal manyetik rezonans görüntüleme (MRG), 2'sine (%4,2) spinal MRG ve 15'ine (%31,9) hem kraniyal hem de spinal MRG yapıldı. Görüntüleme yapılan hastaların 5'inde (%10,6) patoloji tespit edilmiş olup bunlar; 4'ünde (%8,5) hipoksik-iskemik süreçler ve 1'inde (%2,1) siringomiyeli olarak sıralandı.
Sonuç: Hastaların nörolojik muayenelerinin ve nöromotor gelişimlerinin normal olduğu durumlarda, TW sıklıkla idiyopatik olarak tanımlanır. Bununla birlikte, kişisel veya aile öyküsünde risk faktörleri, nöromotor kilometre taşlarında gecikmeler veya anormal nörolojik bulgular ile başvuran hastalar için tanı daha erken bir aşamada takip edilmelidir.

Keywords

İdiyopatik parmak ucunda yürüme, serebral palsi, çocuk

Children presenting with toe walking: when should concern arise?

Abstract

Purpose: This study aimed to evaluate children who present with tiptoe walking (TW) and to identify potential indicators of underlying medical conditions.
Materials and Methods: Out of the 248 patients who visited the Pediatric Neurology Outpatient Clinic for gait disturbances, 90 individuals aged 1-17 years were identified as exhibiting TW. After excluding those with systemic neurological diseases and pervasive developmental disorders (PDD), the study ultimately included 47 patients. Results: Among the participants, 19 were female (40.5%) and 28 were male (59.5%). The mean age of the patients was 4.9 years (SD ± 3.53). When evaluating the etiology of TW, 30 patients (63.8%) were found to have idiopathic tiptoe walking (ITW), 8 (17%) had cerebral palsy (CP), 6 (12.7%) had Achilles tendon shortness (ATS), 2 (4.2%) had hereditary spastic paraplegia (HSP), and 1 (2.1%) had syringomyelia. Imaging was not performed for 17 patients (36.1%), while cranial magnetic resonance imaging (MRI) was conducted for 13 (27.6%), spinal MRI for 2 (4.2%), and both cranial and spinal MRI for 15 (31.9%). Pathology was detected in 5 of the patients who underwent imaging (10.6%): 4 (8.5%) showed hypoxic-ischemic processes, and 1 (2.1%) showed syringomyelia.
Conclusion: In cases where patients exhibit normal neurological examinations and neuromotor development, TW is often identified as idiopathic. However, for patients presenting with risk factors in their personal or family history, delays in neuromotor milestones, or abnormal neurological findings, a diagnosis should be pursued at an earlier stage.

Keywords

Idiopathic toe walking, cerebral palsy, children

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