Clinical History

Vertigo And Dizziness Program

Most Effective Vertigo Home Remedies

Get Instant Access

Gait and balance difficulties generally present as complaints of slow or unsteady walking and of falls. Questions about the speed of walking, the length of the steps taken, the width between the feet, and any difficulties experienced with initiating walking provide clues to the gait disorder. Additionally, the ability to turn and a tendency to trip or bump into things or appear drunk are important clues. The environment or conditions in which the person finds it difficult to walk also offer clues to the gait pattern and guide the physical examination. The clinician should specifically inquire about difficulties in turning over in bed, getting in or out of a car, and arising from a chair because these can be indicators of imbalance.

Falls require a detailed history because they are unlikely to be observed during the examination. Several recent falls that are clearly remembered by the patient or a family member should be explored in detail. Details of the exact location and activity of the patient when the fall occurred may indicate environmental or patient-related precipitants. Had the patient just arisen from a lying or sitting position, suggesting orthostatic hypotension? Or did the feet "get tangled" while turning around, suggesting incoordination?

Did the patient trip, suggesting weakness of the dorsiflexors of the ankle, increased tone characteristic of spasticity, or the shuffling of parkinsonism? Was there lightheadedness, vertigo, or loss of consciousness, suggesting orthostatic hypotension, a labyrinthine disorder, or syncope? How exactly did the patient fall? Crumpling (breaking at the knees) suggests a loss of consciousness (syncope, seizure) or of strength (transient ischemic attack). Falling backward like a log is particularly common in patients with extrapyramidal disorders. Was falling related in any way to meals, suggesting postprandial hypotension, or to drug intake, suggesting drug-induced hypotension or impairment of attention and coordination?

In other aspects of the history, the physician should probe for evidence of proprioceptive, vestibular, and visual disturbances and for signs of pain or deformity of the bones and joints that could affect gait. Weakness sufficient to disturb balance and gait is generally recognized by the patient. Slowness and clumsiness in other motor activities and dysarthria may offer clues to cerebellar and extrapyramidal disorders. Urinary urgency and incontinence are common in multi-infarct states and normal pressure hydrocephalus. The process of taking the history usually reveals whether the patient's judgment or attention span might contribute to falls.

The mode of onset of gait difficulties gives clues to the disease process producing them. Sudden onset suggests vascular disease; gradual onset suggests a degenerative disorder. The medication history is also very important because some drugs can affect the sensory-motor systems, thereby causing balance and gait disturbances. Examples of such drugs include the benzodiazepines, which affect the vestibular system; phenytoin, which affects the cerebellum; and neuroleptics, which involve the basal ganglia. Falls are associated with sedative-hypnotics, which may affect attention and judgment, and with drugs that produce orthostatic hypotension.


Anatomic Location

Gait Abnormality

Associated Findings

Cerebral cortex




Grasp reflex



Urinary urgency and incontinence

Brain stem


Eye movement and pupillary abnormalities


Basal ganglia


Rigidity, tremor

Hypokinetic gait


Hyperkinetic gait

Chorea and dystonia




Dysmetric limbs

Dysmetric eye movements

Vestibular system



Difficulty with tandem walking

Spinal cord

Spastic gait

Sensory level/loss

Sensory ataxia

Increased DTRs

Babinski's sign

Peripheral nerve

Foot drop

Reduced or absent DTRs

Sensory ataxia

Peripheral weakness

Peripheral sensory loss

Muscle and neuromuscular junction


Hip and shoulder weakness

DTRs, Deep tendon reflexes


Was this article helpful?

0 0
Natural Vertigo And Dizziness Relief

Natural Vertigo And Dizziness Relief

Are you sick of feeling like the whole world Is spinning out of control. Do You Feel Weak Helpless Nauseous? Are You Scared to Move More Than a Few Inches From The Safety of Your Bed! Then you really need to read this page. You see, I know exactly what you are going through right now, believe me, I understand because I have been there & experienced vertigo at it's worst!

Get My Free Ebook

Post a comment