Synopsis
Analyse stance, walking and limb coordination as integrated outputs of cerebellar, vestibular, sensory, pyramidal, extrapyramidal, peripheral and musculoskeletal systems while preventing falls during testing.
- Observe the patient rising, initiating, walking, turning and sitting; record aid and assistance. The gait starts before the formal corridor walk and safety takes precedence over completing every manoeuvre.
- Describe components rather than naming a gait alone: base, posture, stride length, step height, cadence, symmetry, arm swing, foot placement, trunk movement, turning and response to dual task.
- Cerebellar dysfunction can cause broad base, variable step timing, veering, impaired tandem gait, dysmetria, intention tremor, dysdiadochokinesia, nystagmus and scanning or slurred speech.
Key red flags
Marked truncal instability, broad stance, titubation and gait ataxia out of proportion to limb dysmetria points toward vermian or midline cerebellar dysfunction. Acute severe truncal ataxia can be a posterior-circulation emergency.
Investigation priorities
Identify the strength, tone, sensation, eye movement, extrapyramidal, vestibular and joint contributors to gait dysfunction.
Management branches
Abrupt gait failure, limb dysmetria or continuous vertigo with new neurological signs or severe truncal instability.
- Perform ABCDE and glucose, establish last known well and examine speech, gaze, nystagmus, skew, fields, face, all limbs, sensation, coordination and ability to sit or stand safely.
- Activate the stroke service for urgent brain and vascular imaging; do not reassure from a negative FAST screen or an early normal non-contrast CT when the syndrome remains coherent.