Which investigations should be considered for a patient presenting with unexplained gait disturbances?

For a patient presenting with unexplained gait disturbances, the following investigations should be considered:

• Take a detailed alcohol history to assess for alcohol-related causes.
• Check thyroid function tests to exclude thyroid disorders.
• Assess vitamin B12 and folate levels to identify deficiencies that may cause gait ataxia.
• Consider serological testing for gluten sensitivity as part of the assessment for coeliac disease.
• Refer for neurological assessment, especially if the gait disturbance is rapidly progressive or gradually progressive, to enable further specialist investigations and management.

Additionally, for patients with difficulty initiating and coordinating walking (gait apraxia), referral to neurology or elderly care clinics is recommended to exclude normal pressure hydrocephalus.

For sudden-onset unsteady gait, follow stroke and transient ischaemic attack guidelines for assessment and referral.

For patients at risk of falling with gait unsteadiness, consider multifactorial falls risk assessment and referral to falls prevention teams.

These investigations and referrals are aimed at identifying reversible causes and ensuring timely specialist input.

References: NICE NG127