Dysequilibrium is the sensation of falling or imbalance associated with difficulty walking or standing and can arise from abnormalities of the brain, cerebellum, spinal cord, or peripheral nerves. Common causes include Parkinson disease, normal-pressure hydrocephalus, cerebellar degeneration (eg, alcoholic cerebellar degeneration), cerebellar stroke, vertebrobasilar insufficiency (VBI), vitamin B12 deficiency, tabes dorsalis, diabetes mellitus, and multiple sensory deficits. The cranial nerve, cerebellar, gait, and sensory exams may provide critical clues that help focus the diagnosis. Gait disturbances may suggest Parkinson disease (shuffling gait) or cerebellar disease (wide-based gait). Stocking glove sensory deficits are typical of diabetic neuropathy, whereas loss of proprioception suggests posterior column disease (ie, vitamin B12 deficiency, tabes dorsalis, and some compressive spinal lesions). A diagnostic approach is illustrated in Figure 14-6.