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Chapter 28: Loss of Balance and Falls

Robbin Howard; Didi Matthews

Description of the Symptom

This chapter describes pathology that may lead to a loss of balance and falls. A loss of balance can be defined as unsteadiness when sitting, standing, or walking that may result in a stumble, trip, and/or fall. A fall is an unintentional event that results in an individual coming to rest at a lower surface.1

Special Concerns

  • Sudden onset of balance problems or falls

  • Balance problems that occur after trauma that have not yet been discussed with a physician

CHAPTER PREVIEW: Conditions That May Lead to a Loss of Balance and Falls
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CHAPTER PREVIEW: Conditions That May Lead to a Loss of Balance and Falls
T Trauma
COMMON

Benign paroxysmal positional vertigo 554

Traumatic brain injury 566
UNCOMMON

Not applicable
RARE

Not applicable
I Infammation
COMMON

Not applicable
UNCOMMON

Aseptic

Labyrinthitis and neuronitis 558

Multiple sclerosis 560

Septic

Encephalitis 556

Meningitis:

  • Bacterial meningitis 559

  • Viral meningitis 559
RARE

Aseptic

Behçet's disease 554

Creutzfeldt-Jakob disease 556

Inflammatory muscle disease 557

Lyme disease (tick paralysis) 558

Paraneoplastic syndromes 563

Vasculitis (giant cell arteritis, temporal arteritis, cranial arteritis) 566

Septic

Neurosyphilis (tabes dorsalis, syphilitic spinal sclerosis, progressive locomotor ataxia) 562
M Metabolic
COMMON

Neuropathy secondary to diabetes mellitus 561

UNCOMMON

Not applicable

RARE

Vestibular ototoxicity 567
Va Vascular
COMMON

Orthostatic hypotension 562

Stroke (cerebrovascular accident) 565
UNCOMMON

Cerebral aneurysm 555

Transient ischemic attack 565
RARE

Lateral medullary infarction (Wallenberg's syndrome) 558

Vasculitis (giant cell arteritis, temporal arteritis, cranial arteritis) 566

Vertebrobasilar artery insufficiency 566
De Degenerative
COMMON

Parkinson's disease 563
UNCOMMON

Dementia with Lewy bodies 556

RARE

Corticobasal degeneration 555

Fahr's syndrome (familial idiopathic basal ganglia calcification, bilateral striopallidodentate calcinosis) 557

Multiple system atrophy with orthostatic hypotension (striatonigral degeneration, olivopontocerebellar atrophy, Shy-Drager syndrome) 560

Progressive supranuclear palsy (Richardson-Steele-Olszewski syndrome) 564

Spinocerebellar ataxia (spinocerebellar atrophy, spinocerebellar degeneration) 565
Tu Tumor
COMMON

Not applicable
UNCOMMON

Malignant Primary, such as:

• Brain primary tumors 554

Malignant Metastatic, such as:

• Brain metastases 554

Benign:

Not applicable
RARE

Malignant Primary, such as:

• Spinal primary tumors 565

Malignant Metastatic, such as:

• Spinal metastases 564

Benign, such as:

• Acoustic neuroma (vestibular schwannoma) 553

• Angiomatosis (Von Hippel-Lindau disease) 553

• Neurofibromatosis 560
Co Congenital
COMMON

Hydrocephalus 557
UNCOMMON

Not applicable
RARE

Not applicable
Ne Neurogenic/Psychogenic
COMMON

Peripheral neuropathy 564
UNCOMMON

Ménière's disease 559

Neurological complications of acquired immunodeficiency syndrome 561
RARE

Not applicable

Note: These are estimates of relative incidence because few data are available for the less common conditions.

Overview of Loss of Balance and Falls

Any disease affecting cognition, alertness, motivation, or planning also may affect balance.2 It is common for a patient or family members to report a history of falls or loss of balance. Sixty-five percent of the population over the age of 60 may experience dizziness or loss of balance on a daily basis.2 In addition, approximately one-third ...

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