Person walking a tightrope between brain hemispheres, symbolizing stroke risk assessment.

Can a Simple Walk Really Tell You If You're Having a Stroke? The Truth About Vertigo and Gait

Nico Varela in Health & Wellness November 2025 • 4 min read.

"Unsteady? Learn how gait examination and understanding the nuances of vertigo could be your first step toward stroke detection."

Feeling dizzy? Acute vertigo, that sudden spinning sensation, can be alarming. When it hits, one of the first concerns is often: could this be a stroke? Every year, countless individuals rush to the emergency department (ED) fearing the worst. For those experiencing acute vertigo, distinguishing between a benign inner ear issue and a potentially life-threatening stroke is critical.

In the fast-paced environment of an emergency room, doctors need quick, reliable ways to assess patients. One common method is the gait examination—observing how someone walks. But is a normal walk truly enough to rule out a cerebellar stroke, a type of stroke affecting the balance centers in the brain?

A recent short-cut review in the Emergency Medicine Journal dives deep into this question, analyzing multiple studies to determine the reliability of gait examinations in patients with acute vertigo. The findings might surprise you and could change how you think about assessing stroke risk.

The Gait Examination: A Quick Check, But Is It Enough?

Person walking a tightrope between brain hemispheres, symbolizing stroke risk assessment.

The review, led by Alisha Greer and Mark Hewitt, examined 16 relevant studies to evaluate whether a normal gait examination could effectively rule out cerebellar stroke in patients presenting with acute vertigo. The studies considered various factors, including the year and country of publication, patient groups, study types, relevant outcomes, and study weaknesses.

So, what did they find? Here’s a breakdown of the key insights:

Normal Gait Isn't a Guarantee: The most critical finding was that a normal gait examination cannot definitively rule out a cerebellar stroke. In other words, just because someone can walk normally doesn't mean they are in the clear.
Abnormal Gait Raises Concerns: Conversely, the presence of an abnormal gait can be associated with a cerebellar stroke. This means if a person is visibly unsteady or has difficulty walking, the suspicion for stroke should increase.
HiNTS Exam Caveat: The review also highlighted the importance of the HiNTS exam (Head Impulse, Nystagmus, Test of Skew), a three-part test used to assess patients with vertigo. However, the study notes the HiNTS exam cannot be performed on people without nystagmus (involuntary eye movement). In these cases, gait examination becomes even more crucial.

To put this into perspective, imagine a 65-year-old arriving at the ED with acute vertigo. They have no nystagmus, so the HiNTS exam is off the table. You might be tempted to think, “They’re walking fine, it’s probably not a stroke.” But this review suggests caution. A normal gait doesn’t eliminate the need for further investigation if suspicion remains.

The Bottom Line: When in Doubt, Investigate

Ultimately, the review underscores the complexity of diagnosing stroke in patients with vertigo. While a normal gait examination is reassuring, it should not be the sole factor in deciding whether to pursue further diagnostic testing. Doctors need to consider the whole clinical picture, including other symptoms, risk factors, and, when appropriate, advanced imaging techniques. If there’s even a slight suspicion of cerebellar stroke, it’s better to err on the side of caution and investigate further.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is a gait examination and how is it used in the context of stroke detection and vertigo?

A gait examination involves observing how a person walks. It's used in emergency settings to quickly assess patients, especially those with acute vertigo, to help determine if their dizziness could be related to a stroke. However, a normal gait does not definitively rule out a cerebellar stroke, meaning further investigation might still be necessary. Conversely, an abnormal gait raises suspicion for stroke.

What is the HiNTS exam, and how does its utility relate to gait examination in assessing stroke risk for individuals with vertigo?

The HiNTS exam, which stands for Head Impulse, Nystagmus, Test of Skew, is a three-part test used to assess patients experiencing vertigo. It helps differentiate between a benign cause of vertigo and a stroke. However, the HiNTS exam cannot be performed on people without nystagmus, which are involuntary eye movements. In such cases, the gait examination becomes even more important in the initial assessment.

What does it mean if someone has a 'normal gait examination,' and how does that impact the assessment of a potential cerebellar stroke?

A normal gait examination means that a person can walk without visible difficulty or unsteadiness. While a normal gait is reassuring, it does not guarantee the absence of a cerebellar stroke. Research indicates that a normal walk isn't enough to rule out a cerebellar stroke. Therefore, even if a patient walks normally, doctors should consider other symptoms and risk factors and possibly conduct further diagnostic testing if there is still suspicion of a stroke.

What is acute vertigo, and why is it important to consider a possible stroke when experiencing it?

Acute vertigo is the sudden sensation of spinning or dizziness. When experiencing acute vertigo, it's natural to be concerned about the possibility of a stroke. Differentiating between a benign inner ear issue and a potentially life-threatening stroke, such as a cerebellar stroke, is crucial. Tools like the gait examination and the HiNTS exam are used to help make this distinction, but a comprehensive evaluation is necessary for accurate diagnosis.

If a gait examination is normal, what other factors should doctors consider to rule out a cerebellar stroke in patients with vertigo?

If a normal gait examination cannot definitively rule out a cerebellar stroke, doctors need to consider the whole clinical picture. This includes evaluating other symptoms, understanding the patient's risk factors, and utilizing advanced imaging techniques when appropriate. The decision to investigate further should be based on the overall suspicion of stroke, even if the initial gait examination appears normal. It's better to err on the side of caution and investigate further to ensure an accurate diagnosis and timely treatment.