Neurological disorders of gait, balance and posture are both debilitating and common. Adequate recognition of these so-called disorders of axial mobility is important as they can offer useful clues to the underlying pathology in patients with an uncertain clinical diagnosis, such as those early in the course of neurological disorders. Medical teaching programmes typically take classic clinical presentations as the starting point and present students with a representative constellation of features that jointly characterize a particular axial motor syndrome. However, patients rarely present in this way to a physician in clinical practice. Particularly in the early stages of a disease, patients might display just one (or at best only a few) abnormal signs of gait, balance or posture. Importantly, these individual signs are never pathognomonic for any specific disorder but rather come with an associated differential diagnosis. In this Perspective, we offer a new diagnostic approach in which the presenting signs are taken as the starting point for a focused differential diagnosis and a tailored search into the underlying neurological syndrome.

Department of Neurology and Centre of Clinical Neuroscience Charles University and General University Hospital Katerinska 30 Praha 2 Czech Republic

Department of Neurology Oregon Health and Science University Portland Oregon 97239 USA

Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease Toronto Western Hospital and Division of Neurology University of Toronto 399 Bathurst Street 7 Mc412 Toronto Ontario M5T 3K9 Canada and at the Krembil Research Institute 60 Leonard Avenue Toronto Ontario M5T 2S8 Canada

Radboud University Medical Centre Donders Institute for Brain Cognition and Behaviour Department of Neurology PO Box 9101 6500 HB Nijmegen Netherlands

Radboud University Medical Centre Donders Institute for Brain Cognition and Behaviour Department of Rehabilitation PO Box 9101 6500 HB Nijmegen Netherlands

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