What is meant by balance difficulties?
Balance problems can mean you are wobbling, needing support, walking with your legs spread wide, or feeling like your body is pulling in one direction. This can occur with or without dizziness.
Dizziness describes a sensation of spinning, swaying, or fainting, while balance problems are primarily felt when standing or walking. The two symptoms often overlap.
See also the articles about yrsel and balance problems for close-up perspectives.
Common and possible causes of poor balance
Inner ear disorders can cause dizziness and unsteadiness. Impaired vision, incorrect glasses or darkness can impair compensation.
Polyneuropathy reduces sensation in the feet and can make it difficult to know where the body is. Muscle and joint disease, weakness, and pain also affect walking.
Stroke, cerebellar disease, Parkinson's disease, hydrocephalus, and other neurological conditions can cause balance problems. Medications, alcohol, and low blood pressure are common contributing factors.
When are balance problems acute?
Call 112 if you experience sudden loss of balance along with facial asymmetry, weakness, speech problems, visual disturbances, severe headache or difficulty walking.
Seek emergency care in the event of new unsteadiness, head injury, loss of consciousness, persistent vomiting, fever with neck stiffness or rapidly increasing neurological symptoms.
Contact healthcare if balance problems persist, repeated falls, hearing loss or gradual deterioration in gait.
Call 112 if balance problems start suddenly and are combined with weakness, speech problems, vision problems or severe headache.
How are balance problems investigated?
The healthcare provider asks about onset, dizziness, hearing, vision, falls, medications, and neurological symptoms. Blood pressure while lying down and standing can assess orthostatic reaction.
The examination includes gait, eye movements, coordination, strength, reflexes and sensation. An ear and hearing examination may be needed when inner ear disease is suspected.
Blood tests can assess anemia, blood sugar, salts, vitamin deficiencies and thyroid. A physiotherapist can also assess the risk of falls and the need for exercise or assistive devices.
When is MRI brain used?
MRI brain can be used when the examination suggests disease in the brain, cerebellum or other central structures. However, acute suspected stroke should be assessed directly in emergency care.
CT is often used in emergencies because the examination is quick. MRI can provide more detail in certain neurological issues but is not always the first method.
Balance problems from the inner ear, medications, vision, or blood pressure require other tests. A normal MRI does not rule out all causes of balance problems.
How can the risk of falling be reduced during the investigation?
Use support and avoid ladders or driving if you are noticeably unsteady. Remove loose rugs, improve lighting, and wear shoes with good traction.
Get up slowly if the discomfort occurs when standing up. Medications that affect blood pressure, sleep or balance should be reviewed with your healthcare provider but should not be stopped on your own.
Balance and strength training can help with many long-term conditions. Training should be adapted if there is a high risk of falls or an as-yet-undiagnosed neurological weakness.