STEPPING MOVEMENTS INDUCED BY ACUTE SPINAL CORD INJURY

Abstract

Caudal to the forebrain, the generation of basic locomotion is thought to involve a network of neurons in the brainstem and spinal cord. This network consists of the mesencephalic locomotor region (MLR), reticulospinal neurons in the pontomedullary region, and spinal cord locomotor central pattern generators (CPGs).1 In humans, spinal CPGs are thought to be sufficient for generating stepping movement when activated by appropriate sensory or descending inputs.2 However, the anatomic location of descending pathways connecting brainstem and spinal CPGs that initiate stepping movement has not been defined in humans. Here we describe a remarkable patient who developed transient, bilateral, and uncontrollable stepping movements following unintentional puncture injury at the C2 spinal cord level. ### Case report. A 35-year-old woman with unexplained, unremitting headache underwent a diagnostic cervical spinal tap after an unsuccessful lumbar tap. The cervical tap was complicated by cord puncture, immediately after which the patient developed uncontrollable bilateral stepping movements while supine. The stepping movements involved rhythmic, bilateral hip and knee flexion and extension, and occurred paroxysmally about four to five cycles per minute. Simultaneously the patient described an ill-defined urge to move her legs, but stated that this was not in response to pain or discomfort. Neurologic examination identified …