Gait disturbance Resident Survival Guide Microchapters |
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Overview |
Causes |
Diagnosis |
Treatment |
Do's |
Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.
Synonyms and Keywords: gait disturbance management, gait disturbance workup, gait disturbance approach, approach to disequilibrium, approach to imbalance
Gait disturbance refers to an impaired sense or absence of balance or equilibrioception that primarily occurs during standing or walking. Gait disturbance usually occurs without any cephalic sensations like headache, nausea, and vomiting. It may also causes dizziness, but it is typically a more complex category with more continuous symptoms in comparison to the other causes of dizziness, like presyncope and vertigo.
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Shown below is an algorithm summarizing the diagnosis of Gait disturbance according to the American Academy of Neurology guidelines:[1]
Gait disturbance | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
When? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Always with movement (may vary in severity) | Intermittently during movement (may vary in severity and frequency) | Continuous and intermittent disturbances are present at least once | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Continuous | Episodic | Mixed | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Transient inability to create effective stepping? | Unintentional increase in speed, usually with small steps? | Transient imbalance? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Freezing | Festination | Disequilibrium | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Disequilibrium and hypermetria of stance and gait? | Associated with increased postural tone? | Slow or small steps and/or slow or small postural? | Involuntary movements? | Associated with muscle weakness or paralysis? | Static or axial postural deformities? | Secondary to musculoskeletal or central pain? | Present at a higher level? | Difficult to classify the continuous nature of the gait disturbance? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ataxic | Spastic | Bradykinetic/hypokinetic | Dyskinetic/Choreic/Dystonic | Paretic | Trunkal disturbance | Antalgic | Frontal disturbance | Undetermined | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treat the underlying cause.
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