unsteadiness

Unsteadiness is a subjective sensation of imbalance or difficulty maintaining a steady posture or gait. It can occur with standing, walking, or turning, and may be constant or episodic. It is distinct from dizziness, which is a feeling of lightheadedness, and from vertigo, which is a spinning sensation. Unsteadiness may reflect disturbances in vestibular function, proprioception, motor control, or integration of sensory inputs in the brain.

Common causes include inner ear disorders such as benign paroxysmal positional vertigo, vestibular neuritis, or Meniere’s disease; central causes such as cerebellar ataxia, stroke, or neurodegenerative disease; peripheral neuropathy or joint and muscle weakness; medications (antihypertensives, sedatives, some antidepressants); orthostatic hypotension; alcohol or toxin exposure; and age-related decline in balance. Acute unsteadiness with focal neurological signs constitutes a medical emergency.

Evaluation involves history, risk factors, and focused examination. Bedside tests include the Romberg test, tandem walking, and the head impulse test; assessment of orthostatic blood pressure; and evaluation of gait. Further testing may include audiologic or vestibular testing, MRI or CT imaging, and referral to neurology or otolaryngology as needed.

Management targets the underlying cause and safety. Vestibular rehabilitation and balance training can improve stability; drug review and modification; treatment of orthostatic issues; management of cardiovascular or metabolic conditions; and environmental safety measures to reduce fall risk. Prognosis varies with cause and treatment adherence.