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Revision as of 03:50, 31 July 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Vendhan Ramanujam M.B.B.S [2]

Synonyms and keywords: Loss of balance; imbalance; off balance; unsteadiness

Overview

Disequilibrium refers to an impaired sense or absence of balance or equilibrioception, which primarily occurs during standing or walking usually without any cephalic sensations like headache, nausea and vomiting. It is one among the causes of dizziness^[1] and is often accompanied by spatial disorientation.

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular	Acute coronary syndrome, arrhythmia, arteriosclerosis, cardiomyopathy, congestive cardiac failure, dehydration, hypertension, hypotension, microscopic polyangiitis, myocardial infarction, postural hypotension, transient ischaemic attack, vasculitis, vertebral artery dissection
Chemical/Poisoning	Acrylamide, arsenic, gamma-diketone hexacarbons, heavy metals, konzo, lead, mercury, methanol, organophosphates, salicylate poisoning
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Aminophylline, amiodarone, amphotericin B, antihypertensives, antibiotics, anticholinergics, anticonvulsants, antidepressants, aspirin, aurothioglucose, biguanide, bortezomib, capecitabine, carbachol, carbon tetrachloride, celecoxib, chlorpheniramine, cinnarizine, cisplatin, clomifene, colchicine, dapsone, diphenhydramine, disulfiram, diuretics, ethambutol, ethotoin, fluorouracil, hydralazine, hydroxyzine, isoniazid, ixabepilone, lamivudine, leflunomide, linezolid, lithium, mefloquine, melarsoprol, metronidazole, nalidixic acid , neuroleptics, nitrofurantoin, nortriptyline, nucleoside analogues, oxaliplatin, paclitaxel, phenylbutazone, phenytoin, physostigmine, prochlorperazine, pyridoxine, rofecoxib, sedatives, stavudine, suramin, taxol, thallium, toluene, trabectedin, tranquilizers, vaccines, verteporfin, vigabatrin, vincristine
Ear Nose Throat	Impaired hearing
Endocrine	Acromegaly, diabetes mellitus, diabetic amyotrophy, diabetic ketoacidosis, diabetic radiculopathy, hyperthyroidism, hypoparathyroidism, hypothyroidism, phaeochromocytoma
Environmental	Altitude sickness, cold exposure, electrical injury, heat stroke, lathyrism
Gastroenterologic	Celiac disease, chronic liver disease, hepatic cirrhosis, intestinal fistula, primary biliary cirrhosis, pyloric stenosis, tropical sprue, viral hepatitis
Genetic	3-methylglutaconic aciduria, 4H syndrome, abetalipoproteinemia, adrenoleukodystrophy, adrenomyeloneuropathy, alpha-mannosidase deficiency, alpha-methylacyl-CoA racemase deficiency, argininosuccinic aciduria, arylsulphatase A deficiency, aspartoacylase deficiency, ataxia-telangiectasia, ATP6V0A2-related cutis laxa, bilateral frontoparietal polymicrogyria, biotinidase deficiency, carbamoylphosphate synthetase deficiency, carbohydrate deficient glycoprotein syndrome type 1a, CCFDN syndrome, Charlevoix-Saguenay spastic ataxia, Cockayne syndrome, coenzyme Q10 deficiency, dentatorubral-pallidoluysian atrophy, Fabry's disease, familial alphalipoprotein deficiency, Friedreich's ataxia, Gamstorp-Wohlfart syndrome, glucose phosphate isomerase deficiency, GM2 gangliosidosis, Griscelli syndrome, Haw river syndrome, hereditary neuralgic amyotrophy, Huntington disease, hypobetalipoproteinemia, Joubert syndrome, Loken Senior syndrome, Marinesco-Sjogren syndrome, MELAS, MERRF, multiple carboxylase deficiency, Navajo neurohepatopathy, phenylalanine hydroxylase deficiency, Pitt-Hopkins syndrome, progressive external ophthalmoplegia, Refsum disease, Revesz syndrome, Roussy-Levy disease, Sandhoff disease, SeSAME syndrome, Silver syndrome, Troyer syndrome, Unverricht-Lundborg disease, Van der Knaap disease, Von Hippel-Lindau syndrome
Hematologic	Anemia, glucose phosphate isomerase deficiency, haemochromatosis, leukemia, multiple myeloma, pernicious anemia, plasmacytoma, polycythemia vera, sideroblastic anemia
Iatrogenic	No underlying causes
Infectious Disease	Acute necrotizing myelopathy, acute viral myelitis, borrelia burgdorferi, botulism, brainstem encephalitis, brucellosis, cerebellar abscess, chickenpox, coxsackie A virus, cysticercosis, cytomegalovirus polyradiculopathy, diphtheria, encephalomyelitis, endophthalmitis, epidural abscess, epstein-barr virus, Guillain-Barré syndrome, herpes simplex, herpes zoster, HIV, leprosy, lyme disease, malaria, meningoencephalitis, mycoplasma pneumoniae, ophthalmia neonatorum, osteomyelitis, polymyositis, schistosoma, septic arthritis, septicemia, syphilis, tick paralysis, transient synovitis, treponema pallidum, tuberculosis, typhoid fever, viral hepatitis
Musculoskeletal/Orthopedic	Carpal tunnel syndrome, Charcot-Marie-Tooth disease, chondroma, compartment syndrome, connective tissue disease, dermatomyositis, Duchenne muscular dystrophy, Ewing's sarcoma, femoral neuropathy, hereditary neuralgic amyotrophy, herniated vertebral disc, leg fractures, muscle weakness, osteoarthritis, osteochondroma, osteoma, osteomyelitis, osteosarcoma, Pagets disease, peroneal compression at the fibular neck, Perthes disease, septic arthritis, slipped upper femoral epiphysis, tarsal tunnel syndrome , transient synovitis
Neurologic	Acoustic neuroma, acute necrotizing myelopathy, acute viral myelitis, alcoholic polyneuropathy, amyotrophic lateral sclerosis, anti-glutamic acid decarboxylase associated cerebellar ataxia, Arnold-Chiari malformation, ataxia-oculomotor apraxia, basilar migraine, benign paroxysmal vertigo, brainstem encephalitis, carotid-cavernous fistula, cerebellar abscess, cerebellar hypoplasia, cerebellar ataxia, cerebellar dyssynergia, cerebellar hemorrhage, cerebellar tumor, cerebellar vermis agenesis, cerebral palsy, cerebrotendineous xanthomatosis, cerebrovascular disease, ceroid lipofuscinosis, cervical spondylosis, cockayne syndrome, confusional state, copper deficiency myeloneuropathy, cortical visual impairment, Creutzfeldt-Jakob disease, cytomegalovirus polyradiculopathy, Dandy-Walker syndrome, deafferentation, decompression sickness myelopathy, Dejerine Sottas syndrome, dementia, demyelination, diabetic amyotrophy, diabetic radiculopathy, diffuse sclerosis of Schilder, distal hereditary neuronopathy, dural arteriovenous fistula, dyssynergia cerebellaris myoclonica, encephalocele, encephalomyelitis, epidural abscess, epilepsy, episodic ataxia, familial Danish dementia, familial hemiplegic migraine, fetal akinesia-hypokinesia sequence, Friedreich's ataxia, Gerstmann-Sträussler-Scheinker syndrome, giant axonal neuropathy, Haw River syndrome, hereditary amyloid polyneuropathy, hereditary ataxia, hereditary sensory and autonomic neuropathy, hereditary spastic paraplegia, Herniated vertebral disc, hypoxia, idiopathic lumbosacral radiculoplexus neuropathy, idiopathic small fiber neuropathy, intracranial space-occupying lesion, Kearns-Sayre syndrome, Klumpke paralysis, lathyrism, Leigh syndrome, lower motor neuron weakness, lumbosacral plexitis, Machado-Joseph disease, meningoencephalitis, meralgia paresthetica, migraine, mitochondrial ataxia, multifocal motor neuropathy, multiple lentigines syndrome, multiple sclerosis, multiple sensory defect dizziness, multiple system atrophy syndromes, myasthenia gravis, myelopathy, NARP syndrome, neurofibromatosis, normal pressure hydrocephalus, Nothnagel Claude syndrome, obturator neuropathy, olivopontocerebellar atrophy, orthostatic myoclonus, pantothenate kinase, paraneoplastic cerebellar degeneration, paraneoplastic sensory neuropathy, Parkinson disease, Pelizaeus-Merzbacher disease, peripheral neuropathy, polyrediculitis, posterior inferior cerebellar artery syndrome, posterior leucoencephalopathy syndrome , raised intracranial pressure, Sandhoff disease, sciatic neuropathy, spinal arteriovenous malformations, spinal cord tumor, spinal epidural hematoma, spinocerebellar ataxia, stroke, subacute combined degeneration, subacute necrotising encephalomyelopathy, subacute sensory neuronopathy, superior orbital fissure syndrome, syringobulbia, syringomyelia, transient ischaemic attack, transverse myelitis, Unverricht-Lundborg disease, upper motor neuron weakness, urination, Van der Knaap disease, vasculitis, vasovagal attacks, vestibular disorder
Nutritional/Metabolic	2-hydroxyglutarate dehydrogenase deficiency, acute intermittent porphyria, alpha-mannosidase deficiency, alpha-methylacyl-CoA racemase deficiency, argininosuccinic aciduria, arylsulphatase A deficiency, aspartoacylase deficiency, beri-beri, carbamoylphosphate synthetase deficiency, carbohydrate deficient glycoprotein syndrome type 1a, Chester porphyria, citrullinemia, cytosine arabinoside, erythropoietic protoporphyria, GM2 gangliosidosis, Hartnup disease, homocitrullinuria syndrome, hypobetalipoproteinemia, hypocalcemia, hypoglycemia, hyponatremia, isovaleric acidemia, Lesch-Nyhan syndrome, Maple syrup urine disease, metabolic acidosis, multiple carboxylase deficiency, nutritional amblyopia, ornithine transcarbamylase deficiency, phenylalanine hydroxylase deficiency, porphyria, pyruvate carboxylase deficiency, pyruvate dehydrogenase deficiency, Strachan syndrome, uremia, Wilson disease
Obstetric/Gynecologic	Childbirth, menopause, pregnancy
Oncologic	Acoustic neuroma, cerebellar tumors, chondroma, Ewing's sarcoma, Hodgkin's lymphoma, lung carcinoma, neuroblastoma, neurofibromatosis type 1, non-Hodgkin's lymphoma, osteochondroma, osteoma, osteosarcoma, paraneoplastic syndrome, rhabdomyosarcoma, solitary plasmacytoma, spinal cord tumor,
Ophthalmologic	Cataract, central serous chorioretinopathy, congenital cataract, cortical visual impairment, endophthalmitis, Gillespie syndrome, Hoyeraal-Hreidarsson syndrome, hyphema, Miller-Fisher syndrome, ocular ischemic syndrome, ophthalmia neonatorum, progressive external ophthalmoplegia, Purtscher's retinopathy, retinal degeneration, retrolental fibroplasia, visual impairment, vitreous hemorrhage
Overdose/Toxicity	Alcohol toxicity
Psychiatric	No underlying causes
Pulmonary	Asthma exacerbation, chronic obstructive pulmonary disease exacerbation, diffuse pulmonary fibrosis, pleural effusion, pneumonia, pneumothorax, pulmonary edema, pulmonary embolism
Renal/Electrolyte	Renal failure
Rheumatology/Immunology/Allergy	Acute demyelinating encephalomyelitis, ankylosing spondylitis, antiphospholipid antibody syndrome, benign monoclonal gammopathy, connective tissue disease, dermatomyositis, fibromyalgia, gout, Guillain-Barré syndrome, lymphomatoid granulomatosis, microscopic polyangiitis, mixed connective tissue disease, monoclonal gammopathy, polyarteritis nodosa, pseudogout, Reiter's syndrome, rheumatoid arthritis, scleroderma, seronegative spondyloarthritis, Sjögren's syndrome, systemic lupus erythematosus
Sexual	No underlying causes
Trauma	Cerebellar hemorrhage, head injury, leg fractures
Urologic	No underlying causes
Miscellaneous	Amyloidosis, cryoglobulinemia, dysproteinemia, emotions, generalized weakness, hyperventilation, metachromatic leukodystrophy, multiple hamartoma syndrome, Niemann-Pick disease, old age, pain, paraproteinemia, Salla disease, sarcoidosis, Shy-Drager syndrome, sialidosis, Tay-Sachs disease

Causes in Alphabetical Order

References

↑ "Chapter 14: Evaluation of the Dizzy Patient". Retrieved 2009-08-06.

Template:WH Template:WS

[urlChapter_14:_Evaluation_of_the_Dizzy_Patient-1] "Chapter 14: Evaluation of the Dizzy Patient". Retrieved 2009-08-06.

[1]

@@ Line 153: / Line 153: @@
 *[[Amphotericin B]]
 *[[Amyloidosis]]
-*[[Amyotrophic lateral sclerosis ]]
+*[[Amyotrophic lateral sclerosis]]
-*[[Andermann syndrome]]
 *[[Anemia]]
 *[[Ankylosing spondylitis]]
@@ Line 166: / Line 165: @@
 *[[Anxiety]]
 *[[Argininosuccinic aciduria ]]
-*[[Arnold-chiari malformation]]
+*[[Arnold-Chiari malformation]]
 *[[Arrhythmia]]
 *[[Arsenic]]
 *[[Arteriosclerosis]]
 *[[Metachromatic leukodystrophy|Arylsulphatase A deficiency]]
-*[[Aspartoacylase deficiency ]]
+*[[Aspartoacylase deficiency]]
 *[[Aspirin]]
 *[[Asthma|Asthma exacerbation]]
@@ Line 182: / Line 181: @@
 *[[Benign paroxysmal vertigo]]
 *[[Beri-beri]]
-*[[Biguanide ]]
+*[[Biguanide]]
 *[[Bilateral frontoparietal polymicrogyria]]
 *[[Biotinidase deficiency]]
@@ Line 192: / Line 191: @@
 *[[Brucellosis]]
 *[[Capecitabine]]
-*[[Carbachol ]]
+*[[Carbachol]]
 *[[Carbamoylphosphate synthetase deficiency]]
 *[[Carbohydrate deficient glycoprotein syndrome type 1a]]
 *[[Carbon tetrachloride]]
 *[[Cardiomyopathy]]
-*[[Carotid-cavernous fistula ]]
+*[[Carotid-cavernous fistula]]
 *[[Carpal tunnel syndrome]]
 *[[Cataract]]
 *[[CCFDN syndrome]]
-*[[Celecoxib ]]
+*[[Celecoxib]]
 *[[Celiac disease]]
 *[[Central serous chorioretinopathy]]
@@ Line 214: / Line 213: @@
 *[[Cerebrotendineous xanthomatosis]]
 *[[Cerebrovascular disease]]
-*[[Ceroid lipofuscinosis ]]
+*[[Ceroid lipofuscinosis]]
 *[[Cervical spondylosis]]
 *[[Charcot-Marie-Tooth Syndrome|Charcot-Marie-Tooth disease]]