MEDizzy - A 77 year old woman complains of unsteadiness on her feet,

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Ageing and disease

A 77 year old woman complains of unsteadiness on her feet, which started a few months ago and has gradually worsened. She finds it difficult to walk in a straight line, and often overbalances when she turns. On examination, she has no nystagmus or past pointing, tone and power are normal, but Romberg’s test is positive. What is the most likely cause for her unsteadiness?

ExplanationThe lack of nystagmus or past pointing argues against this being due to middle ear, brainstem or cerebellar disease. The normal tone makes Parkinsonian syndromes less likely, although you are not given specific information about bradykinesia. A peripheral neuropathy or dorsal column spinal cord disease would explain the unsteadiness and positive Romberg’s test.