Which features distinguish cerebellar ataxic gait from a pyramidal (spastic) gait?

• A. Cerebellar: wide-based, with intention tremor and truncal ataxia; Spastic: scissoring and brisk reflexes
• B. Cerebellar: spastic steps; Spastic gait: wide-based
• C. Cerebellar: spastic gait; Spastic: ataxic gait
• D. Cerebellar: narrow-based gait; Spastic: clumsy gait

Answer: (A)

Distinguishing cerebellar ataxic gait from a pyramidal (spastic) gait hinges on how coordination and tone are affected during walking. Cerebellar ataxia disrupts coordination and balance, so walking becomes wide-based and unsteady. You’ll also see intention tremor and truncal ataxia, which worsen with precise aiming or movement toward a target. The wide stance is a compensatory strategy to maintain balance, and the limb movements are often irregular as coordination breaks down.

In contrast, a pyramidal or spastic gait reflects upper motor neuron pathology. The legs tend to be stiff and extended, with a tendency toward scissoring of the legs due to adductor spasticity, and reflexes are brisk. This results in a more rigid, less fluid, and sometimes narrow-based gait.

So the best answer combines wide-based gait with intention tremor and truncal ataxia for cerebellar involvement, and scissoring with brisk reflexes for spastic gait. The other options mix up these hallmark signs and don’t fit the classic patterns.