Table 1.
Disturbances of gait, corresponding anatomy, and etiology
| AFFECTED STRUCTURE | CLINICAL FEATURE | COMMON ETIOLOGIES |
|---|---|---|
| Cortical (mostly frontal) or subcortical | Cautious, Parkinsonian (short steps, short arm swing), magnetic (feet barely leave the floor), apractic (lacking the skill of walking), ataxic (impaired control), spastic (hypertonic, jerking) | Periventricular white matter disease, normal pressure hydrocephalus, frontal vascular lesions, frontal tumors, parietal lesions |
| Basal ganglia | Parkinsonian (most specific are turning problems, hesitation/freezing, festination) | Parkinson disease, drug-induced, vascular |
| Thalamus (less common cause of gait disturbance) | Astasia (subjective imbalance, positive Romberg sign), ataxia (contralateral ataxia and sensory loss) | Vascular injuries in posterolateral thalamus |
| Cerebellum | Ataxia (midline and legs with vermal damage, appendicular and arms with hemispheric damage) | Toxic (EtOH, benzodiazepines, anticonvulsants), vascular, infectious/ inflammatory, demyelinating, metabolic, tumor, trauma, paraneoplastic |
| Brainstem | Variations on ataxia | Midbrain, pontine, and medulla infarcts |
| Spinal cord | Spastic (stiff appearance, “kicking” steps, bilateral leg circumduction), scissoring (with more severe spasticity) | Osteoarthritis, trauma, B12 deficiency, inflammation, demyelination, tumor, abscess, several others |
| Proprioceptive nerves | Sensory ataxia, sensory gait (impaired with eyes closed), positive Romberg sign | Diabetic neuropathy, Guillain Barre, other demyelinations |
| Vestibular input | Cautious, slightly wide base, tandem impaired by wide base, positive Romberg sign | Unilateral: vestibular neuritis, Meniere disease; bilateral: gentamicin toxicity |
| Visual | Visual disequilibrium: subjectively off balance, but balance and gait normal | Post-cataract or lens surgery, new visual corrective lenses |
| Muscle, neuromuscular junction | Waddling, steppage gait/foot drop, hyperextended knee | Proximal myopathies, myasthenia |
| Orthopedic | Antalgic gait | degenerative joint disease, acute orthopedic injury |