Falls in older adults almost never have one cause. They come from several small deficits acting together: medication effects, a blood pressure that drops on standing, poor vision, weak legs, and a neurological problem affecting balance or sensation. The neurologist's job is to find the parts that are treatable, because removing two or three contributors often stops the falls even when the others cannot be changed.
Falls in older adults almost never have one cause. They come from several small deficits acting together: medication effects, a blood pressure that drops on standing, poor vision, weak legs, and a neurological problem affecting balance or sensation. The neurologist's job is to find the parts that are treatable, because removing two or three contributors often stops the falls even when the others cannot be changed.
Peripheral neuropathy removes the position sense the feet use to report where the ground is, and it is the reason many people fall in the dark or on uneven paving. Parkinsonism narrows and slows the gait and impairs the reflex that catches you. Cervical myelopathy from spinal cord compression produces a stiff, clumsy walk with hand symptoms. Normal pressure hydrocephalus classically pairs a magnetic gait with urinary urgency and slowed thinking. Vestibular problems including benign paroxysmal positional vertigo cause position-triggered spinning. Each of these has a different treatment, which is why the label 'unsteady' is not a diagnosis.
Sedatives, sleep aids, some antidepressants, anticholinergics, opioids and overtreated blood pressure account for a large share of falls, and the fix costs nothing. Bring every bottle, including anything bought over the counter and any supplement, to the appointment. A medication list read off a phone misses the two drugs that matter more often than people expect.
This changes everything. Tripping and knowing you tripped is mechanical. Losing consciousness, even briefly, points to syncope or a seizure and needs a different evaluation: cardiac rhythm assessment for the first, EEG and imaging for the second. Ask whoever saw it whether you were responsive on the floor, because your own memory of that moment is not reliable evidence.
History about the circumstances of each fall, an examination of strength, sensation, reflexes, tone and gait, and observation of you walking and turning. From there, EMG and nerve conduction studies if neuropathy is suspected, VNG balance testing where the story suggests a vestibular cause, and EEG if a seizure is possible. All of those are performed in these offices. MRI, when the examination points to the spinal cord or brain, is arranged at an imaging centre and the report reviewed with you.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: falls; National Institute of Neurological Disorders and Stroke; National Institute on Aging.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.