question-icon

What causes weakness in legs and balance issues in an elderly person?

default
Posted on Wed, 11 May 2016
Question: My dad for the last 2 weeks started with his legs feeling weak. His legs just give way underneath him and he falls. I am so worried whats wrong or what could be wrong. Dad has been sent for an xray tomorrow and having other investigations. What could be wrong and will he ever be able to walk again with correct treatment? He is only 67
doctor
Answered by Dr. Abhay A Mali (1 hour later)
Brief Answer:
Need clinical examination.

Detailed Answer:
Hi,

Thanks for your question.

Sorry to read about your father.

There is a need for detailed clinical examination including neurological examination.
There might be possibility of stroke (paralytic attack) which may be cause of sudden weakness in half side of body including leg.
If weakness is bilateral there is a need to evaluate for neuropathy and spine examination.
Low blood sugar (hypoglycemia) may also lead to similar scenario.

Only after clinical examination need for further evaluation like brain or spinal cord imaging or nerve conduction study can be decided.

After fall if there is any bony injury (fracture) which may be evident on appropriate xrays.
Depending upon injury further treatment can be planned.

Get back with his investigations reports for better opinion.

Hope this helps.

Regards,
Dr. Abhay Mali.
Diabetologist.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Abhay A Mali (39 minutes later)
It is both legs if its diabetic neuropathy can it be controlled or will mobility be lost. He can walk at the moment with a stick but keeps falling. All pulses in legs are normal and normal reflexes
doctor
Answered by Dr. Abhay A Mali (6 hours later)
Brief Answer:
Recovery may be expected.

Detailed Answer:
If it is due to diabetic peripheral neuropathy recovery may be expected.
In such case I may suggest –
- Blood tests like
HbA1c
Kidney function test including serum electrolytes, uric acid.
Liver Function Test.
Calcium profile.
Complete blood count.
Vitamin B12 & D level.
T3, T4, TSH.
- Good blood sugar control.
- Blood Pressure and Cholesterol control.
- Assessment of postural fall in blood pressure which may be due to diabetic autonomic neuropathy or amitryptillin.
- If there is abnormal dizziness, muscle twitching, low sodium level stopping Amitryptillin may help. (It may worsen neuropathy pain alternate medicine like pregabalin or tramadol in severe cases may be used.
- Maintain good nutrition especially protein intake.
- Take help of physiotherapist for gradual exercise program.

Hope for speedy recovery.

Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Abhay A Mali (30 hours later)
We went to GP yesterday he has stopped Amitriptyline and put Dad on Gabapentin hope this is a better drug.
We went to Diabetes centre who is really pleased with Dad his overall HbA1c is 59 they said range was up to 58 so it being over by 1 they are really not concerned.
Today we see Endocrinologist so hopefully then can help. 
I am really worried and keep crying Dad has lost his mobility. How long after stopping Amitriptyline should he get leg use back please?
Dad also had knee xray yesterday awaiting results.
Its Dads left leg that keeps giving way says right is weak but not as bad as left.
There is no history to suggest a stroke etc.

Thanks in advance for your help



Been to Endocrinologist he sending Dad for assessment for a Stroke I really think it is Amitriptyline related but better to be safe. Please let me know your thoughts asap I am worried sick. Dad has had no symptoms of blurred vision speech arm weakness drooping face etc so I am still thinking its Amitriptyline related
doctor
Answered by Dr. Abhay A Mali (4 hours later)
Brief Answer:
Better to do further evaluation.

Detailed Answer:
As weakness is restricted to lower limb and is unequal it is suggested to get evaluated for stroke.
Depending upon neurological examination there may be need for MRI brain with Angiography (for stroke) or MRI of lumbo-sacral spine (for spinal cord injury or disc prolaps) or Nerve conduction study (for neuropathy).

Once this neurological evaluation done one can in a better position to comment on cause of problem and it's prognosis.

If all of neurological evaluation is negative amitryptillin might be the culprit.

Don't be so stressed out.
You have to take care of your father.

Hope for early recovery.


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
default
Follow up: Dr. Abhay A Mali (22 hours later)
It has been confirmed my Dad has had a Stroke that has affected his legs causing him to fall. They have said Physio wont help him he has been assessed by Physio but say tablets can help him. Will he get use back in legs from taking tablets he is on 300mg of Aspirin and not sure what else. They think it is a blocked artery in neck from CT scan and are saying tablets can sort this problem out but I thought he would have to have some kind of an opening artery operation, is it true it can be sorted by tablets they say it is a minor stroke. I just want my Dad to get his mobility back and stop another stroke happening is this possible please?
doctor
Answered by Dr. Abhay A Mali (5 hours later)
Brief Answer:
Good recovery is expected.

Detailed Answer:
As there is a involvement of lower leg only there is a likely possibility of involvement of very small area of brain (which may be affected by lack of blood supply) and good recovery may be expected.

The usual treatment for that is use of anti-platelet like Ecosprin (blood thinner), statins (cholesterol lowering medicine) good control of blood pressure and blood sugar and physiotherapy.

About recovery one can comment only after detailed clinical examination and brain imaging findings.



Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
default
Follow up: Dr. Abhay A Mali (48 hours later)
My dads left leg still keeps giving way and I am worried sick it will never recover. Dads discharge summary is as follows: bloods crp 28, hba1c 69, nil else remarkable
ECG: sinus tachycardia, US carotid doppler <50% stenosis b/l
Examination revealed Left LL 4/5 hip/knee extensions and the rest was not remarkable. A diagnosis of ischaemic stroke has been made.
CT brain report as above.


Sorry hba1c is 60 not 69

CT report: long standing areas of focal low attenuation at the posterior aspect of the right striatum and within the left lentiform nucleus. No acute intracranial hammorhage or infarction. No evidence of acute intracranial abnormality.


I still think this is due to Amitriptyline as dad does feel his leg is a bit stronger i worry he has lost all mobility
doctor
Answered by Dr. Abhay A Mali (18 hours later)
Brief Answer:
Can expect good recovery.

Detailed Answer:
HI..

Diagnosis of Ischemic stroke which means there is brain injury due to lack of blood supply.
Many of the time CT brain miss the Ischemic injury. MRI brain with angiography will give much better information.
Power of 4/5 has good chance of recovery with antiplatelts, statin, good diabetes & blood pressure control and physiotherapy.

Regards.
Above answer was peer-reviewed by : Dr. Deepak
doctor
Answered by
Dr.
Dr. Abhay A Mali

Diabetologist

Practicing since :2006

Answered : 807 Questions

premium_optimized

The User accepted the expert's answer

Share on
What causes weakness in legs and balance issues in an elderly person?

Brief Answer: Need clinical examination. Detailed Answer: Hi, Thanks for your question. Sorry to read about your father. There is a need for detailed clinical examination including neurological examination. There might be possibility of stroke (paralytic attack) which may be cause of sudden weakness in half side of body including leg. If weakness is bilateral there is a need to evaluate for neuropathy and spine examination. Low blood sugar (hypoglycemia) may also lead to similar scenario. Only after clinical examination need for further evaluation like brain or spinal cord imaging or nerve conduction study can be decided. After fall if there is any bony injury (fracture) which may be evident on appropriate xrays. Depending upon injury further treatment can be planned. Get back with his investigations reports for better opinion. Hope this helps. Regards, Dr. Abhay Mali. Diabetologist.