Challenging differential diagnosis, Rare disease
Arash Ghaffari-Rafi, Richard D. Horak, Daniel T Miles, Ki Suk Eum, Jay Jahanmir
(John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA)
Am J Case Rep 2019; 20:1587-1591
Fear of falling syndrome is a rare and often-missed disorder among patients with new-onset gait abnormality. The disorder is often mistaken for an organic neurologic problem, with some considering it to be a medical emergency.
CASE REPORT: This case report presents a 70-year-old man who presented to the Emergency Department due to inability to rise from a chair or ambulate independently. Onset of his chief complaint occurred subsequent to a traumatic fall in a public location. He underwent extensive workup, and an organic neurologic cause was ruled out. He was subsequently diagnosed with fear of falling syndrome after obtaining a detailed fall history, as well as utilizing a verified survey (the Falls Efficacy Scale-International). After extensive inpatient treatment, the patient improved significantly. However, upon discharge to a skilled nursing facility, he was not offered the recommended treatment. When he was readmitted for an unrelated reason 3 months later, he had regressed to the state he was in at the time of prior admission.
CONCLUSIONS: This case presents a rare debilitating but reversible gait disorder, and highlights the importance of assessing “fall history” and fear of falling in older adults. Uniquely, this case presents the rapid fluctuation in outcomes dependent on treatment, and what happens when a patient fails to complete treatment regimens. The report also provides an overview of fear of falling with the corresponding gait disorder.
Keywords: Accidental Falls, Gait, Neurology