Assessment of unexplained falls and gait unsteadiness: the impact of age

When a patient with a balance disorder reports rotational vertigo, the clinician rightly focuses his or her attention on the vestibular system. This article reviews the possible diagnoses in the many patients who primarily report falls or gait disorder. Falls can be caused by predisposing neurologic conditions impairing gait, cardiovascular conditions, or epileptic episodes. The proportion of idiopathic falls, however, remains high. In the elderly, environmental circumstances, visual defects, psychotropic medication, and poor general health are additional risk factors. Clinical assessment of gait is more revealing and less expensive than computerized posture/ gait systems. The diagnosis of orthostatic tremor, however, requires either Fourier analysis of sway platform signals or electromyography.