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J R Soc Med. 2002 March; 95(3): 137.
PMCID: PMC1279484

The man who walks backwards

Adrian R Brown, MRCPsych and Malcolm Peet, FRCPsych1

Backward walking is sometimes a manifestation of psychosis, but not always.

CASE HISTORY

A man aged 53 experienced trouble with coordination at the age of 5. He had had a difficult delivery. Nocturnal grand mal seizures developed at age 8, and between 18 and 21 severe myoclonus confined him to bed, surrounded by pillows in a high-sided cot because of uncontrollable flailing arm movements. He recovered apart from residual torticollis but 5 years later developed a depressive illness. Psychotic features emerged subsequently—persecutory delusions and episodes of bizarre behaviour accompanying a variety of changes in mood. He used a meat cleaver to prune shrubs and he was found arranging the branches across a road near the family home. Other unusual behaviours included sitting in a deck chair in the pouring rain. There was a partial relapse of his myoclonus at age 31.

In his early 40s the torticollis began to worsen and was accompanied by increasing lumbar spine pain as he twisted his torso to compensate for a deviated field of vision. An occupational therapist suggested he try walking backwards, and this he did with some success. Although finding road crossing difficult he became rapidly able to manage his shopping, pulling a trolley behind him. Friends nicknamed him ‘The Sidewinder’. He exhibits a broad-based gait but no other cerebellar signs or focal neurological features. He now never walks forwards unless asked. Psychiatrically he has been symptom free for many years on a combination of lithium carbonate and antipsychotics. There is no evidence to suggest the backward walking is associated with any psychotic symptoms or disturbance of mood.

COMMENT

Although this patient had experienced psychotic illness, his backward walking is a functional accommodation to a physical disorder. It was clearly an act of will: to become automatic, backward walking requires a drastic change in the locomotor programme1. The patient is not embarrassed by his potentially stigmatizing behaviour. Neurologically he meets broad diagnostic criteria for the Ramsay—Hunt syndrome2—ataxia, myoclonus, grand mal—though no longer experiencing seizures. Intracranial disease is sometimes linked with mood disorders3,4 such as he experienced but his CT scans, and electroencephalograms performed in adult life, have been normal.

Acknowledgments

We thank Dr Sean Spence for helpful comments.

References

1. Thorstensson A. How is the normal locomotor program modified to produce backward walking? Exp Brain Res 1986;61: 664-8 [PubMed]
2. Marsden CD, Harding AE, Obeso JA, Lu CS. Progressive myoclonic ataxia (the Ramsay Hunt syndrome). Arch Neurol 1990;47: 1121-5 [PubMed]
3. DelBello MP, Strakowski SM, Zimmerman ME, et al. MRI analysis of the cerebellum in bipolar disorder: a pilot study. Neuropsycho-pharmacology 1999;21: 63-8 [PubMed]
4. Soares JC, Mann JJ. The anatomy of mood disorders—review of structural neuroimaging studies. Biol Psychiatry 1997;41: 86-106 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press