Gait unsteadiness in adults - NICE guidance - suspected neurological conditions - recognition and referral

Gait unsteadiness in adults

Summary points from NICE guidance relating to unsteadiness of gait in adults are:

Sudden-onset unsteady gait

• if assessing sudden-onset unsteady gait in adults, then consider as possible TIA/stroke and assess accordingly

Rapidly progressive unsteady gait (gait ataxia)

• refer urgently adults with rapidly (within days to weeks) progressive unsteady gait (gait ataxia) for neurological assessment.

Gradually progressive unsteady gait (gait ataxia)

Refer adults with gradually progressive unsteady gait (gait ataxia) for neurological assessment and:

• take an alcohol history and manage as per alcohol-use disorders if indicated:
  • diagnosis, assessment and management of harmful drinking and alcohol dependence
• check thyroid function
• check for vitamin B12 and folate deficiency
• consider serological testing for gluten sensitivity

Difficulty initiating and coordinating walking (gait apraxia)

• refer adults who have difficulty initiating and coordinating walking (gait apraxia) to neurology or an elderly care clinic to exclude normal pressure hydrocephalus
  
  
• for adults with unsteadiness of gait who are at risk of falling, then undertake a multifactorial falls risk assessment and consider referring to a falls prevention team

Reference:

• NICE (May 2019). Suspected neurological conditions: recognition and referral