From the Research
The initial workup for unsteady gait should begin with a comprehensive history and physical examination, focusing on neurological assessment, as recommended by the most recent study 1 from 2021. This approach is crucial in identifying the underlying cause of the unsteady gait, which could range from neurological disorders, peripheral neuropathy, vestibular dysfunction, medication side effects, or metabolic abnormalities. The neurological examination should include:
- Assessment of mental status
- Cranial nerves
- Motor strength
- Sensation
- Deep tendon reflexes
- Coordination tests (finger-to-nose, heel-to-shin)
- Specific gait evaluation including tandem walking Laboratory tests should include:
- Complete blood count
- Comprehensive metabolic panel
- Vitamin B12
- Folate
- Thyroid function tests
- Hemoglobin A1c Consider toxicology screening if medication effect is suspected, as seen in a case where venlafaxine was associated with central pontine myelinolysis 2. Brain imaging with CT or MRI is important to rule out structural lesions, with MRI being preferred due to better visualization of posterior fossa pathology, as highlighted in a study on gait disorders in adults and the elderly 3. Additional testing may include:
- Electroencephalography if seizures are suspected
- Nerve conduction studies for peripheral neuropathy
- Vestibular function tests for vertigo In elderly patients, medication review is crucial as polypharmacy often contributes to gait instability, as noted in a study on evaluating the child with unsteady gait 4 and another on vitamin B12 deficiency 5. This systematic approach helps identify the underlying cause, allowing for targeted treatment and prevention of falls, which are a significant source of morbidity, especially in older adults.