Gait Disorders: Or something else? Differential Diagnosis

Eyes and ocular appendages (H00-H59).

  • Visual acuity reduction

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Hashimoto’s thyroiditis – autoimmune disease leading to chronic thyroiditis.
  • Hyponatremia (sodium deficiency).
  • Hypothyroidism (hypothyroidism)
  • Vitamin B12 deficiency

Cardiovascular system (I00-I99)

  • Arterial circulatory disorder (peripheral arterial disease, pAVD; intermittent claudication → intermittent claudication).

Infectious and parasitic diseases (A00-B99).

Musculoskeletal system and connective tissue (M00-M99).

  • Osteoarthritis
  • Polymyositis – autoimmune disease from the series of collagenoses, which predominantly affects the muscles.

Neoplasms – tumor diseases (C00-D48).

  • Brain tumors, unspecified
  • Tumors of the central nervous system

Ears – mastoid process (H60-H95)

Psyche – nervous system (F00-F99; G00-G99).

  • Amyotrophic lateral sclerosis (ALS) – degenerative disease of the motor nervous system.
  • Anxiety/phobia
  • Apoplexy (stroke)
  • Asterixis (“flapping of wings”; flutter tremor) – in chronic liver or kidney failure.
  • Ataxia with vitamin E deficiency (AVED) – neurodegenerative disease from the group of hereditary cerebellar ataxias with mutation in the TTPA gene; characterized by: progressive spino-cerebellar ataxia (SCA), loss of proprioception (perception of body movement and position in space or the position of individual body parts in relation to each other), areflexia (absence of reflexive responses to stimuli) and association with significant deficiency of vitamin E.
  • Autoimmune encephalitis – encephalitis (inflammation of the brain) triggered by immunoglobulin class G (IgG) antibodies against the body’s own tissues; immunoglobulins against NMDA receptors and the so-called leucine-rich glioma inactivated protein 1 (LGI1) have been identified as the most common triggers of antibody-mediated encephalitis; the different triggers lead to different clinical pictures:
  • Huntington’s chorea (synonyms: Huntington’s chorea or Huntington’s disease; older name: St. Vitus’ dance) – genetic disorder with autosomal dominant inheritance characterized by involuntary, uncoordinated movements accompanied by flaccid muscle tone.
  • Dementia
  • Depression
  • Disc prolapse (herniated disc)
  • Dystrophia myotonica – myotonic muscle disease with muscle weakness, lens opacity and hypogonadism (gonadal hypofunction).
  • Epidural abscess – accumulation of pus between the calvaria of the skull and the dura mater/hard meninges.
  • Episodic ataxia (EA) – likely to occur with paroxysmal onset of ataxia; onset usually in childhood or adolescence; autosomal dominant disorder, although family history may be negative due to spontaneous mutations and incomplete penetrance.
  • Familial spastic spinal paralysis – results in spastic leg paralysis.
  • Drop foot (synonym: pointed foot) with the toe hanging downward due to paralysis of the peroneal (fibular) nerve
  • Fragile X tremor ataxia syndrome (FXTAS) – rare neurodegenerative disorder with adult-onset gait disturbance and increasing intention tremor (form of tremor (shaking) when approaching a target).
  • Friedreich’s ataxia (Friedreich’s disease) – degenerative disease of the central nervous system; onset usually before the age of 25; progresses progressively, although its symptomatology may remain stable for years.
  • GAD antibody encephalitis (GAD = glutamate decarboxylase).
  • Gang apraxia (frontal gait disorder).
  • Infantile cerebral palsy – neurological disorder whose causative damage to the central nervous system occurs before, during, or immediately after birth.
  • Hyponatremic encephalopathy (hyponatremia/sodium deficiency affects gait more than a blood alcohol level of 0.6 g/l)
  • Hysteria
  • Infantile cerebral palsy – neurological disorder whose causative damage to the central nervous system occurs before, during or immediately after birth.
  • Kauda syndrome – paraplegic syndrome at the level of the cauda equina of the spinal cord; symptomatology: flaccid paresis (paralysis) of the lower extremities in the area of the affected nerve roots.
  • Cerebellar degeneration
  • Conversion reactions – mental symptoms that cannot be characterized by organic findings.
  • Corticobasal degeneration – degeneration of a part of the brain.
  • Mantle edge process – damage to the mantle edge of the cerebrum.
  • Binswanger’s disease (subcortical arteriosclerotic encephalopathy, SAE) – brain changes caused by arteriosclerotic vascular damage.
  • Fahr’s disease (synonyms: Fahr’s syndrome, Fahr’s syndrome) – symmetric calcification of the basal ganglia that may be associated with neurological and psychiatric symptoms; clinical presentation: headache, speech disorders, a slowly progressive dementia, and extrapyramidal symptoms; movement disorders, as well as tremors and muscle stiffness
  • Parkinson’s disease (shaking paralysis).
  • Multiple sclerosis (MS) – demyelinating disease of the central nervous system.
  • Muscular dystrophy (muscle atrophy), unspecified.
  • Multisystem atrophy – neurological disorder that presents with the symptoms of Parkinson’s disease but is more severe.
  • Myasthenia gravis (MG; synonyms: myasthenia gravis pseudoparalytica; MG); rare neurological autoimmune disorder in which specific antibodies against the acetylcholine receptors are present, with characteristic symptoms such as abnormal load-dependent and painless muscle weakness, asymmetry, in addition to local also a temporal variability (fluctuation) over the course of hours, days or Weeks, an improvement after recovery or rest periods; clinically can be differentiated a purely ocular (“concerning the eye”), a faciopharyngeal (face (Facies) and pharynx (pharynx) concerning) emphasized and a generalized myasthenia; about 10% of cases already show a manifestation in childhood.
  • Myasthenia – pathological muscle fatigability.
  • Myelitis (inflammation of the spinal cord)
  • Normal pressure hydrocephalus – “hydrocephalus”, but in which no increased intracranial pressure is detectable; the reason is cerebral atrophy
  • Paraneoplastic cerebellar degeneration (PCD) – autoimmune disease of the cerebellum with severe ataxias, but unimpaired consciousness.
  • Polyneuropathygeneric term for certain diseases of the peripheral nervous system affecting multiple nerves.
  • Primary lateral sclerosis – systemic disease that is notable primarily for muscle atrophy and paralysis.
  • Primary pallidal degeneration – disruption of a truncal ganglion; important component of the extrapyramidal system.
  • Progressive supranuclear palsy – cranial nerve loss due to damage above the core area.
  • Sleep-related breathing disorders (SBAS):
  • Somatoform disorders – physical complaints referred to, which can not or not sufficiently be attributed to an organic disease.
  • Spinalis-anterior syndrome – neurological disorders caused by circulatory disturbances of the spinal artery anterior.
  • Spinocerebellar ataxias (SCA) – group of clinically similar neurodegenerative disorders; symptomatology: dependent on the focus of degeneration.
  • Stiff-man syndrome (SMS; synonyms: Stiff-person syndrome, SPS; Moersch-Woltman syndrome); neurologic disorder characterized by a generalized increase in tone of the muscles; in addition, spasms occur spontaneously or triggered in the affected muscles; usually the back and hip muscles are symmetrically affected; Gait becomes stiff-legged and bizarre; many have insulin-requiring diabetes mellitus (30%), autoimmune thyroiditis (autoimmune disease leading to chronic thyroiditis; 10%), atrophic gastritis (gastritis) with pernicious anemia (vitamin B12 deficiency anemia (anemia); 5%).
  • Syringomyelia – destruction of the tissue of the spinal cord due to defective development.
  • Tropical spastic paraparesis – neurological disorder caused by infection with human T-lymphotropic virus 1 (HTLV-1).
  • Vascular encephalopathy – brain disorders caused by vascular changes.
  • Cerebellar ataxias (ARCA) – heterogeneous group of rare genetic disorders of the central and peripheral nervous system with autosomal recessive inheritance; sometimes other systems or organs are affected.
  • Cervical myelopathy – disease affecting the cervical portion of the spinal cord, which occurs mainly in spinal stenosis.

Symptoms and abnormal clinical and laboratory findings not classified elsewhere (R00-R99)

  • Pain, especially in the lower extremity.
  • Vertigo (dizziness), esp. in old age → gait unsteadiness.

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Alcohol intoxication
  • Traumatic brain injury (TBI)
  • Trauma (back or legs)

Medication

Environmental pollution – intoxications (poisoning).

  • Alcohol intoxication or chronic alcohol abuse,