Difficulty in walking

Dorn Spinal Therapy

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Spinal TB may cause difficulty in walking. So first make sure (by clinical examination and spine X-ray) that the patient does not also have spinal TB.

The cause of difficulty walking in a TB/HIV patient may be HIV-related (spinal cord myelopathy and occasionally peripheral neuropathy) or unrelated to HIV. A patient with difficulty walking and HIV myelopathy usually has a spastic paraparesis. It is only possible to make this diagnosis by excluding the causes of spinal cord disease unrelated to HIV.The table below shows the main causes of spinal cord disease unrelated to HIV, and the diagnostic tests. In HIV-related peripheral neuropathy, sensory disturbance tends to predominate over motor weakness.

Cause of spinal cord disease Diagnostic tests

cervical spondylosis

cervical spine X-ray, myelography

prolapsed intervertebral disc


epidural abscess


treatable tumours


(neurofibroma, meningioma)


identification of eggs in stool, urine,

or rectal snips



syphilis serology, CSF findings

subacute combined

anaemia with raised MCV, low serum

degeneration of the cord

vitamin BI2 level

Spinal cord schistosomiasis is difficult to diagnose, but schistosomiasis is easy to treat. If a patient with a spinal cord problem lives in an area endemic for schistosomiasis, give empirical treatment with a single dose of praziquantel (40 mg/kg) while pursuing further management.

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