Gait abnormalities DDx

Gait abnormalities – Differential Diagnosis

Common causes

• Joint pain
• Hip OA/weakness
• Parkinson’s disease
• Alcohol
• Labyrinthitis
• Meniere’s disease
• Peroneal nerve palsy
• Psychogenic

Must Not Miss

• Spinal cord compression
• Stroke
• Cerebellar disease
• Frontal lobe lesions

Easily missed

• Peripheral polyneuropathy
  • Diabetic neuropathy
  • Alcohol
  • Vitamin B12 deficiency
  • Metabolic
  • Connective tissue diseases
  • Heavy metals
  • Paraneoplastic syndrome
  • Idiopathic & others

Red flags

• Confusion/behavioural change
• Neck/Back or leg symptoms with
  • Loss of bladder/bowel control
  • ‘Clumsy’ /numb hands
• Other neurological symptoms
  • Change in vision
  • Slurred speech
  • Limb weakness
• Progressive symptoms

Investigations to consider

• FBC, CRP/ESR
• U+Es, LFTs, TFTs, Bone profile, Serum glucose, B12 + Folate
• Auto-antibody screen
• Serum protein electrophoresis
• HIV screen
• Toxicology screen
• Local X-Ray
• NCS + EMG
• MRI scan (head & spine)