Drop attack

Drop attacks are sudden spontaneous falls while standing or walking, followed by a very swift recovery, within seconds or minutes. This phenomena is usually caused by a temporary drop in blood supply to the anterior lobe of the cerebellum (anterior vermis). Similar to a 'faint' episode without loss of consciousness.

Causes
Drop attacks are typically seen in elderly patients, and the most common cause is carotid sinus hypersensitivity, resulting in either short periods of reversible asystole, or in marked drop in blood pressure in response to carotid sinus stimulation.

Other causes include the following:


 * 1) vascular - transient ischemic attack, cerebrovascular accident, dissection, occlusion, hemorrhage
 * 2) * intracranial hematoma
 * 3) * posterior circulation infarction, emboli, vasospasm
 * 4) * bilateral anterior circulation occlusion
 * 5) * migraine accompagnee - develop over 1 hour with associated paresthesia and headache
 * 6) * basilar artery insuff - occurs in older patients, with no loss of consciousness, transient loss of lower extremity tone
 * 7) epilepsy/paroxysmal
 * 8) * neurally mediated syncope - 75% of all causes
 * 9) * Atonic seizure
 * 10) * Lennox-Gastaut syndrome - atonic, myoclonic, generalized tonic-clonic seizures, typically in patients with neurological abnormalities
 * 11) * Juvenile Myoclonic Epilepsy - fall with myoclonus
 * 12) * cataplexy associated with narcolepsy
 * 13) * periodic paralyses
 * 14) * complex partial seizure
 * 15) * breath holding spells - associate pallor/cyanosis, emotional aspect
 * 16) * pure autonomic failure (Riley Day, long standing diabetes mellitus)
 * 17) * episodic ataxia
 * 18) * Panayiotopoulos syndrome
 * 19) degenerative
 * 20) * postural instability with Parkinsons
 * 21) structural
 * 22) * chronic odontoid instability
 * 23) * spinal cord trauma with transient paraplegia
 * 24) * brainstem mass
 * 25) metabolic
 * 26) * hypoglycemia, hypocalcemia, hypomagnesemia
 * 27) * toxins, drugs - cocaine, sedatives, antihistamine, tricyclic antidepressants (TCAs)
 * 28) cardiac
 * 29) * prolonged QT interval, tachycardia, bradycardia, sick sinus syndrome, arrhythmia, idiopathic hypertrophic subaortic stenosis (IHSS), AS
 * 30) * hypovolemia
 * 31) psychiatric
 * 32) * malingering, conversion disorder, panic, anxiety
 * 33) labyrinth hydrops: an overflow of endolymph in ear labyrinth causes distortions and breaks; see also Ménière's syndrome

Diagnosis

 * important if there was an inciting event (neuroleptic malignant syndrome, breatholding, postural), any loss of consciousness, and presence of postictal period
 * initially get blood glucose, EKG, pregnancy test, urine toxicology screen, CT scan of the head, electrolytes
 * later consider EEG, echocardiogram, MRI, tilt test