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plantar- exed at the ankle and the weight is carried on the toes; or the foot may be dorsi exed or inverted An involuntary movement may cause the leg to be suspended in the air momentarily, imparting a lilting or waltzing character to the gait, or it may twist the trunk so violently that the patient may fall In dystonia musculorum deformans and focal axial dystonias, the rst symptom may be a limp due to inversion or plantar exion of the foot or a distortion of the pelvis One leg may be rigidly extended or one shoulder elevated, and the trunk may assume a position of exaggerated exion, lordosis, or scoliosis Because of the muscle spasms that deform the body in this manner, the patient may have to walk with knees exed The gait may seem normal as the rst steps are taken, the abnormal postures asserting themselves as the patient continues to walk Prominence of the buttocks owing to a lumbar lordosis, combined with exion of one or both legs at the hip, gives rise to the so-called dromedary gait of Oppenheim In the more advanced stages, walking becomes impossible owing to torsion of the trunk or the continuous exion of the legs The general features of choreoathetosis and dystonia are described more fully in Chap 4

ten an early and prominent feature In addition, the gait is uncertain and hesitant features that are enhanced, no doubt, by the hazard of falling unpredictably The cause of the toppling phenomenon is unclear; it does not have its basis in weakness, ataxia, or loss of deep sensation It appears to be a disorder of balance that is occasioned by precipitant action or the wrong placement of a foot and by a failure of the righting re exes Slowness of motor response is another factor When the defect is due to a central vestibular disorder, the patient may describe a sense of being pushed (pulsion) rather than of imbalance In midbrain disease, including progressive supranuclear palsy, a remarkable feature is the lack of appreciation of a sense of imbalance In the advanced stages of Parkinson disease, falling of a similar type may be a serious problem, but it is perhaps surprising how relatively infrequently it occurs Primary Orthostatic Tremor (see page 84) This unusual fast tremor of the legs may devastate gait As discussed in Chap 6, it is present only when the patient walks or exerts force with the legs while seated In reaction to a perception of severe imbalance, which is characteristic of the disorder, the patient assumes a widened and often stiff-legged stance

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There are several types of mass storage (besides the hard drive) in which data can be kept in large quantities Computer experts categorize mass storage in two ways: access time and cost per megabyte In general, the less the access time (that is, the faster the storage medium), the greater the cost per megabyte The fastest mass storage media usually have the lowest capacity

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