Primary postural instability: a cause of recurrent sudden falls in the elderly

Neurol Sci. 2006 Dec;27(6):412-6. doi: 10.1007/s10072-006-0720-x.


Elderly patients with recurrent falls are frequently diagnosed with an extrapyramidal syndrome. This study aims to characterise a distinct group of patients with recurrent falls and postural instability as a hallmark of the clinical examination. The study took place in the Movement Disorders Unit, Rabin Medical Center, Petah Tiqva, Israel among 26 patients with recurrent falls who had no clinical evidence of a neurodegenerative disease. Medical records, neurological examination and brain imaging studies were assessed. Falls in these patients were sudden, unprovoked, with no vertigo or loss of consciousness. All had postural instability with minimal or no abnormality on the neurological examination. Brain imaging showed diffuse ischaemic changes in 65%. [(123)I]-FPCIT SPECT with the dopamine transporter ligand, performed in five patients, was normal in all. Recurrent falls might be caused by a neurological syndrome that primarily affects balance control. The importance of identifying this disorder is its distinction from other parkinsonian syndromes causing falls.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls*
  • Aged
  • Aged, 80 and over
  • Basal Ganglia Diseases / diagnostic imaging
  • Basal Ganglia Diseases / physiopathology
  • Brain Infarction / diagnostic imaging
  • Brain Infarction / physiopathology
  • Female
  • Humans
  • Iodine Radioisotopes
  • Male
  • Movement Disorders / diagnostic imaging
  • Movement Disorders / physiopathology
  • Neurodegenerative Diseases / diagnostic imaging
  • Neurodegenerative Diseases / physiopathology*
  • Neurologic Examination
  • Postural Balance*
  • Posture*
  • Tomography, Emission-Computed, Single-Photon / methods
  • Tropanes


  • Iodine Radioisotopes
  • Tropanes
  • 2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane