Balance/walking/co-ordination

Balance/walking/co-ordination

Reassure

  • Motor abnormality with obvious local cause e.g. injury, inflammation or infection
  • No associated symptoms or signs
  • No risk factors for a brain tumour
  • No other abnormalities detected on examination

Review/refer

  • Motor abnormality present for less than two weeks
  • No obvious local cause
  • No high risk conditions
  • No associated symptoms or signs

Scan

New onset motor abnormality that may occur with a brain tumour:

  • Ataxic gait
  • Abnormal coordination
  • Focal motor weakness (e.g. hemiplegia/hemiparesis/altered hand preference)
  • Head tilt
  • Persistent motor regression/loss of motor skills
  • Persistent swallowing difficulties without local cause
  • New onset facial weakness that shows no improvement within four weeks
  • Other neurological or endocrinological symptoms or signs, including poor growth

Diagnostic pitfalls

  • Attributing an unsteady walk (ataxic gait) to an ear infection without corroborative ear findings
  • Not considering swallowing difficulties and recurrent aspiration as a cause of "chestiness" in children.

Examination/assessment

  • Assess motor skills including:
    • Sitting/crawling in infants
    • Walking/running in older children
    • Co-ordination e.g. heel-toe walking, finger-nose testing
    • Fine motor skills, e.g. handling of a small toy / cup in young children
    • Handwriting in school age children and young people
    • Touching tip of thumb with tip of each finger of the same hand in turn in school age children and young people
  • Ask specifically about associated symptoms and risk factors:
    • Personal or family history of a brain tumour
    • Leukaemia
    • Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
    • Neurofibromatosis types 1 and 2
    • Tuberous Sclerosis
    • Li Fraumeni Syndrome
    • Family history of colorectal polyposis
    • Gorlins Syndrome
    • Other familial genetic syndromes
  • Neurological examination (include assessment of vision (including acuity), gait and coordination)
  • Plot growth in all children and pubertal status if applicable
  • Plot head circumference in children under two