Disequilibrium causes

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

Overview

Disequilibrium is the result of a dysfunction at one or more points in the complex system required for balance and ambulation. Disequilibrium may be caused by abnormalities in the visual, motor, sensory, cerebellar and vestibular systems.

Causes

Life Threatening Causes

• Arrhythmia
• Asthma exacerbation
• Cerebellar hemorrhage
• Compartment syndrome
• Endophthalmitis
• Epilepsy
• Hypoglycemia
• Organophosphates

Common Causes

• Cerebellar disorders
• Gait abnormality
• Hypoglycemia
• Paralysis
• Peripheral neuropathy
• Vestibular disorders
• Visual impairment

Causes by Organ System

Cardiovascular	Acute coronary syndrome, arrhythmia, arteriosclerosis, cardiomyopathy, congestive heart failure, dehydration, hypertension, hypotension, microscopic polyangiitis, myocardial infarction, postural hypotension, transient ischaemic attack, vasculitis, vertebral artery dissection
Chemical/Poisoning	Acrylamide, arsenic, 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	Hearing impairment
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, Charlevoix-Saguenay spastic ataxia, Cockayne syndrome, coenzyme Q10 deficiency, De Grouchy Syndrome, 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, MPV17 gene mutation, multiple carboxylase deficiency, phenylalanine hydroxylase deficiency, progressive external ophthalmoplegia, Refsum disease, 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, plasmacytoma, spinal cord tumor
Ophthalmologic	Cataract, central serous chorioretinopathy, cortical visual impairment, endophthalmitis, Hoyeraal-Hreidarsson syndrome, hyphema, Miller-Fisher syndrome, ocular ischemic syndrome, ophthalmia neonatorum, progressive external ophthalmoplegia, 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, drop attack, 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

2-hydroxyglutarate dehydrogenase deficiency 3-methylglutaconic aciduria 4H syndrome Abetalipoproteinemia Acoustic neuroma Acromegaly Acrylamide Acute coronary syndrome Acute demyelinating encephalomyelitis Acute intermittent porphyria Acute necrotizing myelopathy Acute viral myelitis Adrenoleukodystrophy Adrenomyeloneuropathy AIDS Alcohol dependence Alcohol toxicity Alcoholic polyneuropathy Alpha-mannosidase deficiency Alpha-methylacyl-coa racemase deficiency Altitude sickness Aminophylline Amiodarone Amphotericin B Amyloidosis Amyotrophic lateral sclerosis Anemia Ankylosing spondylitis Antihypertensives Anti-glutamic acid decarboxylase associated cerebellar ataxia Antibiotics Anticholinergics Anticonvulsants Antidepressants Antiphospholipid antibody syndrome Anxiety Argininosuccinic aciduria Arnold-Chiari malformation Arrhythmia Arsenic Arteriosclerosis Arylsulphatase A deficiency Aspartoacylase deficiency Aspirin Asthma exacerbation Ataxia-oculomotor apraxia Ataxia-telangiectasia ATP6V0A2-related cutis laxa Aurothioglucose Basilar migraine Benign monoclonal gammopathy Benign paroxysmal vertigo Beri-beri Biguanide Bilateral frontoparietal polymicrogyria Biotinidase deficiency Borrelia burgdorferi Bortezomib Botulism Brainstem encephalitis Briquet's syndrome Brucellosis Capecitabine Carbachol Carbamoylphosphate synthetase deficiency Carbohydrate deficient glycoprotein syndrome type 1a Carbon tetrachloride Cardiomyopathy Carotid-cavernous fistula Carpal tunnel syndrome Cataract Celecoxib Celiac disease Central serous chorioretinopathy 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 Charcot-Marie-Tooth disease Charlevoix-saguenay spastic ataxia Chester porphyria Chickenpox Childbirth Chlorpheniramine Chondroma Chronic liver disease Chronic obstructive pulmonary disease exacerbation Cinnarizine Cisplatin Citrullinemia Claude syndrome Clomifene Cockayne syndrome Coenzyme Q10 deficiency Colchicine Cold exposure Compartment syndrome Confusional state Congestive cardiac failure Connective tissue disease Copper deficiency myeloneuropathy Cortical visual impairment Coxsackie A virus Creutzfeldt-Jakob disease Cryoglobulinemia Cysticercosis Cytomegalovirus polyradiculopathy Cytosine arabinoside Dandy-Walker syndrome Dapsone Deafferentation Decompression sickness myelopathy De Grouchy Syndrome Dehydration Dejerine Sottas syndrome Dementia Demyelination Dentatorubral-pallidoluysian atrophy Depression Dermatomyositis Diabetes mellitus Diabetic amyotrophy Diabetic ketoacidosis Diabetic radiculopathy Diffuse pulmonary fibrosis Diffuse sclerosis of Schilder Diphenhydramine Diphtheria Distal hereditary neuronopathy Disulfiram Diuretics Dothiepin Drop attack Duchenne muscular dystrophy Dural arteriovenous fistula Dysproteinemia Dyssynergia cerebellaris myoclonica

Electrical injury Emotions Encephalocele Encephalomyelitis Endophthalmitis Epidural abscess Epilepsy Episodic ataxia Epstein-barr virus Erythropoietic protoporphyria Ethambutol Ethotoin Ewing's sarcoma Fabry's disease Familial alphalipoprotein deficiency Familial danish dementia Familial hemiplegic migraine Femoral neuropathy Fetal akinesia-hypokinesia sequence Fibromyalgia Fluorouracil Friedreich's ataxia Gamstorp-Wohlfart syndrome Generalized weakness Gerstmann-Sträussler-Scheinker syndrome Giant axonal neuropathy Glucose phosphate isomerase deficiency GM2 gangliosidosis Gout Griscelli syndrome Guillain-Barré syndrome Haemochromatosis Hartnup disease Haw river syndrome Head injury Heat stroke Heavy metals Hepatic cirrhosis Hereditary amyloid polyneuropathy Hereditary ataxia Hereditary neuralgic amyotrophy Hereditary sensory and autonomic neuropathy Hereditary spastic paraplegia Herniated vertebral disc Herpes simplex Herpes zoster HIV Hodgkin's lymphoma Homocitrullinuria syndrome Hoyeraal-Hreidarsson syndrome Huntington disease Hydralazine Hydroxyzine Hypertension Hyperthyroidism Hyperventilation Hyperventilation syndrome Hyphema Hypobetalipoproteinemia Hypocalcemia Hypochondriasis Hypoglycemia Hyponatremia Hypoparathyroidism Hypotension Hypothyroidism Hypoxia Hysteria Idiopathic lumbosacral radiculoplexus neuropathy Idiopathic small fiber neuropathy Impaired hearing Intestinal fistula Intracranial space-occupying lesion Isoniazid Isovaleric acidemia Ixabepilone Joubert syndrome Kearns-Sayre syndrome Klumpke paralysis Konzo Lamivudine Lathyrism Lead Leflunomide Leg fractures Leigh syndrome Leprosy Lesch-Nyhan syndrome Leukemia Linezolid Lithium Loken Senior syndrome Lower motor neuron weakness Lumbosacral plexitis Lung carcinoma Lyme disease Lymphomatoid granulomatosis Machado-Joseph disease Major depression Malaria Malingering Maple syrup urine disease Marinesco-Sjogren syndrome Mefloquine Melarsoprol MELAS Meningoencephalitis Menopause Meralgia paresthetica Mercury MERRF Metabolic acidosis Metachromatic leukodystrophy Methanol Metronidazole Microscopic polyangiitis Migraine Miller-Fisher syndrome Mitochondrial ataxia Mixed connective tissue disease Monoclonal gammopathy MPV17 gene mutation Multifocal motor neuropathy Multiple carboxylase deficiency Multiple hamartoma syndrome Multiple lentigines syndrome Multiple myeloma Multiple sclerosis Multiple sensory defect dizziness Multiple system atrophy syndromes Muscle weakness Myasthenia gravis Mycoplasma pneumoniae Myelopathy Myocardial infarction Nalidixic acid NARP syndrome Neuroblastoma Neurofibromatosis type 1 Neuroleptics Neuronal ceroid lipofuscinosis Niemann-Pick disease Nitrofurantoin Non-Hodgkin's lymphoma Normal pressure hydrocephalus

Nortriptyline Nothnagel Claude syndrome Nucleoside analogues Nutritional amblyopia Obturator neuropathy Ocular ischemic syndrome Old age Olivopontocerebellar atrophy Ophthalmia neonatorum Organophosphates Ornithine transcarbamylase deficiency Orthostatic myoclonus Osteoarthritis Osteochondroma Osteoma Osteomyelitis Osteosarcoma Oxaliplatin Paclitaxel Pagets disease Pain Pantothenate kinase Paraneoplastic cerebellar degeneration Paraneoplastic sensory neuropathy Paraneoplastic syndrome Paraproteinemia Parkinson disease Pelizaeus-Merzbacher disease Peripheral neuropathy Pernicious anemia Peroneal compression at the fibular neck Perthes disease Phaeochromocytoma Phenylalanine hydroxylase deficiency Phenylbutazone Phenytoin Physostigmine Plasmacytoma Pleural effusion Pneumonia Pneumothorax Polyarteritis nodosa Polycythemia vera Polymyositis Polyrediculitis Porphyria Posterior inferior cerebellar artery syndrome Posterior leucoencephalopathy syndrome Postural hypotension Pregnancy Primary biliary cirrhosis Prochlorperazine Progressive external ophthalmoplegia Pseudogout Pulmonary edema Pulmonary embolism Pyloric stenosis Pyridoxine Pyruvate carboxylase deficiency Pyruvate dehydrogenase deficiency Radiotherapy Raised intracranial pressure Refsum disease Reiter's syndrome Renal failure Retinal degeneration Retrolental fibroplasia Rhabdomyosarcoma Rheumatoid arthritis Rofecoxib Roussy-levy disease Salicylate poisoning Salla disease Sandhoff disease Sarcoidosis Schistosoma Schizophrenia Sciatic neuropathy Scleroderma Sedatives Septic arthritis Septicemia Seronegative spondyloarthritis SeSAME syndrome Shy-Drager syndrome Sialidosis Sideroblastic anemia Silver syndrome Sjögren's syndrome Slipped upper femoral epiphysis Spinal arteriovenous malformations Spinal cord tumor Spinal epidural hematoma Spinocerebellar ataxia Stavudine Strachan syndrome Stroke Subacute combined degeneration Subacute necrotising encephalomyelopathy Subacute sensory neuronopathy Superior orbital fissure syndrome Suramin Syphilis Syringobulbia Syringomyelia Systemic lupus erythematosus Tarsal tunnel syndrome Taxol Tay-Sachs disease Thallium Thiamine deficiency Tick paralysis Toluene Trabectedin Tranquilizers Transient ischemic attack Transient synovitis Transverse myelitis Treponema pallidum Tropical sprue Troyer syndrome Tuberculosis Typhoid fever Unverricht-Lundborg disease Upper motor neuron weakness Uremia Urination Vaccines Van der Knaap disease Vasculitis Vasovagal attacks Vertebral artery dissection Verteporfin Vestibular disorder Vigabatrin Vincristine Viral hepatitis Visual impairment Vitamin B1 deficiency Vitreous hemorrhage Von Hippel-Lindau syndrome Wilson disease Xeroderma pigmentosum Zalcitabine