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Screening People on Standing Balance with Romberg Testing and Walking Balance with Tandem Walking
Published on: September 1, 2023
Evaluating the child with unsteady gait
1Department of Pediatrics, King Abdul-Aziz University Hospital, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. Tel. +996 (2) 6401000 Ext. 20208. Fax. +996 (2) 6403975.
Insights
Unsteady gait in children requires careful evaluation to rule out serious conditions like meningitis or brain tumors. This review guides clinicians in distinguishing serious causes from benign ones to ensure appropriate care and avoid unnecessary hospitalizations.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
Background:
- Unsteady gait is a frequent reason for pediatric emergency and neurology consultations.
- Differentiating serious neurological disorders from benign or non-neurological causes is critical for appropriate patient management.
Purpose of the Study:
- To present a clinical approach for evaluating unsteady gait in children.
- To discuss diagnostic considerations, investigations, treatment, and prognosis for pediatric ataxia.
Main Methods:
- Review of clinical approaches to unsteady gait in pediatric populations.
- Discussion of differential diagnoses including cerebellar and sensory ataxia.
- Emphasis on detailed history and physical examination to guide investigations.
Main Results:
- Ataxia can be categorized as cerebellar or sensory, with diverse underlying causes for each.
- Cerebellar ataxia may stem from trauma, infections, metabolic issues, degenerative diseases, tumors, or congenital anomalies.
- Sensory ataxia results from peripheral neuropathy or spinal cord dysfunction affecting proprioception.
Conclusions:
- A systematic clinical assessment, including thorough history and examination, is essential for diagnosing the cause of unsteady gait in children.
- Accurate diagnosis facilitates targeted investigations, appropriate treatment, and improved patient outcomes, preventing unnecessary medical interventions.
Abstract:
Unsteady gait is a relatively common presentation to the pediatric emergency and neurology services. Unsteadiness can be due to a wide variety of causes, however, the primary concern on initial assessment is to exclude serious disorders such as meningitis, encephalitis, or brain tumors. Recognizing benign and non-neurological causes of unsteady gait is essential to avoid unnecessary investigations and hospital admission. In this review, a clinical approach to the unsteady child is presented with discussion of diagnostic considerations, approach to investigation, treatment, and prognosis. Ataxia can be cerebellar or sensory. Cerebellar ataxia can be acute, chronic, progressive, or episodic. It may result from trauma, infections, metabolic, degenerative disease, space occupying lesions, or congenital anomalies. Sensory ataxia is due to peripheral neuropathy involving large myelinated fibers that carry vibration and position sense, or due to posterior spinal column dysfunction. Accurate assessment depends on detailed history, examination, and then formulation of a differential diagnosis list to guide laboratory investigations.
