Nonvestibular Vertigo

Episodic or persistent nonvestibular vertigo often manifests itself as staggering, unsteady gait, and loss of balance. The possible causes include disturbances of the oculomotor apparatus, cerebellum, or spinal cord; peripheral neuropathy; intoxication; anxiety (phobic attacks of vertigo); hyperventilation; metabolic disorders; and cardiovascular disease.

Unsteady Gait

Rotatory vertigo

(positional, chronic)

Rotatory vertigo

(positional, chronic)

Nonvestibular vertigo

(unsteady posture/gait; nondirectional vertigo)

Utricle Cupula

Otolith in posterior semicircular canal

Utricle Cupula

Otolith in posterior semicircular canal

Semicircular Canals

Semicircular canal after repositioning

Benign peripheral paroxysmal positional vertigo

Semicircular canal after repositioning

Benign peripheral paroxysmal positional vertigo

Normal Gait

Posture. The assumption of an upright posture and the maintenance of balance (postural reflexes) are essential for walking upright. Locomotion requires the unimpaired function of the motor, visual, vestibular, and somatosensory systems. The elderly cannot stand up as quickly and tend to walk somewhat unsteadily, with stooped posture and broader steps, leading to an elevated risk of falling.

Locomotion. Normally, walking can be initiated without hesitation. The gait cycle (time between two successive contacts of the heel of one foot with the ground = 2 steps) is characterized by the gait rhythm (number of steps per unit time), tO the step length (actually the length of an entire o cycle, i.e. 2 steps), and the step width (distance c s o §

between the lines of movement of the two heels, roughly 5-10 cm). Touchdown is with the heel of the foot. Each leg alternately functions as the supporting leg (stance phase, roughly 65% of the gait cycle), and as the advancing leg (swing phase, roughly 35% of the gait cycle). During the shifting phase, both feet are briefly in contact with the ground (double-stance phase, roughly 25% of the stance phase). Because the body's center of gravity shifts slightly to the side with each step, the upper body makes small compensatory movements to maintain balance. The arms swing alternately and opposite to the direction of leg movement. Normally, the speed of gait can be changed instantaneously. In old age, the gait sequence is less energetic and more hesitant, and turns tend to be carried out en bloc.

Gait Disturbances

Description

Related Terms

Site of Lesion

Possible Cause

Antalgic gait

Limping gait, leg difference, limp

Foot, leg, pelvis, spinal column

Lumbar root lesion, bone disease, peripheral nerve compression

Steppage gait

Foot-drop gait

Sciatic or peroneal nerve, spinal root L4/5, motor neuron

Polyneuropathy, peroneal paresis; lesions of motor neuron, sciatic nerve, or L4/5 root

Waddling gait

Duchenne gait, Trendelenburg gait, gluteal gait

Paresis of pelvic girdle muscles (Duchenne) or of gluteal abductors (Trendelenburg)

Myopathy, osteomalacia; lesions of the hip joint or superior gluteal nerve; L5 lesion

Toe-walking

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