Abnormalities | Suggestions for differential diagnosis* |
Quiet standing (eyes open) |
Normal to narrowed base of support | |
Widened base of support | - Sensitive but nonspecific
- Vestibular ataxia, sensory ataxia, cerebellar ataxia, chorea
- Atypical parkinsonism
|
Progressive instability | - Orthostatic tremor, negative myoclonus, functional gait disorders
|
Excessive spontaneous sway | - Dyskinesia (eg, PD, Huntington disease), higher-level gait disorders, functional gait disorders
|
Leaning or drifting sideways | - Vertebral column deformities
- Pisa syndrome: Either drug-induced (eg, dopamine receptor antagonists) or associated with neurodegeneration (AD, PD, atypical parkinsonism)
- Pusher syndrome (unilateral thalamic stroke), trunk dystonias (including idiopathic Pisa syndrome)
|
Excessive trunk flexion that persists when lying down | - Vertebral column deformities
|
Excessive trunk flexion that disappears when lying down | - Trunk or hip weakness (myasthenia gravis, motor neuron disease, myopathies)
- Camptocormia (PD, atypical parkinsonism)
|
Stance width |
Narrowed base of support | - PD, spastic paraparesis (eg, hereditary spastic paraparesis)
|
Widened base of support | - Nonspecific
- Atypical parkinsonism, cerebellar ataxia, sensory ataxia, vestibular ataxia, higher-level gait disorders
- Extreme in some functional gait disorders
|
Scissoring of the legs | - Spastic paraparesis (eg, juvenile cerebral palsy), dystonia, higher-level gait disorders, Huntington disease (due to chorea), compensation for freezing of gait (eg, in PD), functional gait disorders
|
Unable to walk in a straight line, sideways deviation (veering) of gait | - Unilateral vestibular ataxia, unilateral cerebellar ataxia (consistently veering in a direction ipsilateral to the lesion), functional gait disorders (often veering from side to side)
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