Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 08: A 65-year-old with falls
Feb 20, 2019
A focused clinical case about a 65-year-old with recurrent falls and how to tell falls from syncope. Careful neurologic exam clues narrow localization and point to frontal gait disorder and possible communicating hydrocephalus. Contrasts with cerebellar and sensory ataxias. Practical tips on observing standing and walking to evaluate gait.
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Frontal Gait Apraxia Points To Communicating Hydrocephalus
- Gait apraxia (frontal gait disorder) presents with difficulty initiating gait, wide-based short shuffling steps, and trouble turning.
- These signs plus preserved strength, normal cerebellar testing, and absent sensory loss point to communicating hydrocephalus as a top cause.
Group Positives And Negatives To Localize Gait Problems
- Grouping positive findings (difficulty rising, initiating gait, turning instability) against negatives (no weakness, no cerebellar signs, no sensory loss) clarifies localization.
- Difficulty rising suggests proximal motor involvement but here reflects impaired motor planning rather than true weakness.
Cerebellar Ataxia Preserves Gait Initiation And Shows Dysmetria
- Cerebellar causes like alcoholic cerebellar degeneration or multiple system atrophy give wide-based gait but preserve gait initiation and show dysmetria on finger-to-nose or heel-to-shin.
- Falls are usually later in cerebellar disease and motor/sensory signs are evident earlier.
