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balance disorder

(also see dizziness, falls, ataxia) Etiology: 1) disturbance in the vestibular system a) peripheral - saccular & semicircular canal dysfunction common with aging b) central 2) disturbance in proprioception 3) disturbance in vision 4) musculoskeletal disorder a) muscle weakness b) pain associated with maintaining balance (arthritis) 5) stroke [1] (especially imbalance without dizziness) Clinical manifestations: 1) a sensation of dizziness or vertigo 2) falling or a feeling of falling 3) lightheadedness or feeling woozy 4) visual blurring 5) disorientation 6) secondary manifestations a) nausea/vomiting b) diarrhea c) faintness d) changes in heart rate & blood pressure e) fear f) anxiety g) panic 7) reactions to the symptoms of dizziness include a) fatigue b) depression c) decreased concentration Laboratory: - no laboratory indicated prior to structured exercise program (see management) [3] - also see dizziness, falls Special laboratory: - Clinical Test for Sensory Interaction on Balance Radiology: see dizziness, falls Complications: - see dizziness, falls - balance disorders associated with an increased risk of all-cause, cardiovascular & cancer mortality [4] Management: - patient may benefit from assistive device - structured, supervised exercise program that includes balance training & resistance training to improve muscle strength - see dizziness, falls

Related

ataxia; dyssynergia balance balance evaluation

General

sign/symptom

References

  1. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006 Oct;37(10):2484-7. Epub 2006 Aug 31. PMID: 16946161
  2. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  3. Salzman B. Gait and balance disorders in older adults. Am Fam Physician. 2010 Jul 1;82(1):61-8. PMID: 20590073
  4. Cao C, Cade WR, Li S et al Association of Balance Function With All-Cause and Cause-Specific Mortality Among US Adults. JAMA Otolaryngol Head Neck Surg. Published online March 11, 2021 PMID: 33704356 PMCID: PMC7953337 (available on 2022-03-11) https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2777174
  5. NIDCD Balance Disorder http://www.nidcd.nih.gov/health/balance/balance_disorders.asp
  6. NIDCD Balance, Dizziness and You http://www.nidcd.nih.gov/health/balance/baldizz.asp
  7. HIH Senior Health: Balance problems http://nihseniorhealth.gov/balanceproblems/toc.html