Drop attack

Drop attack

WikiDoc Resources for Drop attack
Articles
Most recent articles on Drop attack Most cited articles on Drop attack Review articles on Drop attack Articles on Drop attack in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Drop attack Images of Drop attack Photos of Drop attack Podcasts & MP3s on Drop attack Videos on Drop attack
Evidence Based Medicine
Cochrane Collaboration on Drop attack Bandolier on Drop attack TRIP on Drop attack
Clinical Trials
Ongoing Trials on Drop attack at Clinical Trials.gov Trial results on Drop attack Clinical Trials on Drop attack at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Drop attack NICE Guidance on Drop attack NHS PRODIGY Guidance FDA on Drop attack CDC on Drop attack
Books
Books on Drop attack
News
Drop attack in the news Be alerted to news on Drop attack News trends on Drop attack
Commentary
Blogs on Drop attack
Definitions
Definitions of Drop attack
Patient Resources / Community
Patient resources on Drop attack Discussion groups on Drop attack Patient Handouts on Drop attack Directions to Hospitals Treating Drop attack Risk calculators and risk factors for Drop attack
Healthcare Provider Resources
Symptoms of Drop attack Causes & Risk Factors for Drop attack Diagnostic studies for Drop attack Treatment of Drop attack
Continuing Medical Education (CME)
CME Programs on Drop attack
International
Drop attack en Espanol Drop attack en Francais
Business
Drop attack in the Marketplace Patents on Drop attack
Experimental / Informatics
List of terms related to Drop attack

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Drop attacks are sudden spontaneous falls while standing or walking, followed by a very swift recovery, within seconds or minutes.

Common causes

• seizure
• transient ischemic attack
• cerebrovascular accident
• basilar artery insufficiency
• hypoglycemia
• hypotension
• cataplexy associated with narcolepsy
• cardiac arrhythmia
• sick sinus syndrome
• migraine
• aortic stenosis
• conversion disorder

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
   • intracranial hemm
   • posterior circulation infarction, emboli, vasospasm
   • bilateral anterior circulation occlusion
   • migraine accompagnee - develop over 1hr with assoc paresthesia, HA
   • basilar artery insuff - older pt with no LOC, transient loss of LE tone
2. epilepsy/paroxysmal
   • neurally mediated syncope - 75% of all causes
   • Myoclonic seizure, astatic seizure, or petit mal syndrome
   • Lennox Gaustaut - atonic, myoclonic, GTC typically in neuro abnormal pt
   • Juvenile Myoclonic Epilepsy - fall with myoclonus
   • laugh or cough triggered epilepsy
   • cataplexy associated with narcolepsy
   • periodic paralysis
   • complex partial seizure
   • reatholding spells - associate pallor/cyanosis, emotional aspect
   • pure autonomic failure (Riley Day, long standing DM)
   • episodic ataxia
   • Panayiotopoulos syndrome
3. degenerative
   • postural instability with Parkinsons
4. structural
   • chronic odontoid instability
   • spinal cord trauma with transient paraplegia
   • brainstem mass
5. metabolic
   • hypoglycemia, hypocalcemia, Hypomagnesemia
   • toxins, drugs - cocaine, sedatives, antihistamine, TCA
6. cardiac
   • prolonged QT, tachycardia, bradycardia, sick sinus syndrome, arhythmia, IHSS. AS
   • hypovolemia
7. psych
   • malingering, conversion, panic, anxiety

Diagnosis

• important if there was an inciting event (NMS, breatholding, postural), any LOC, and presence of postictal pd
• initially get glucose, EKG, pregnancy test, Utox, CT head, lytes
• later consider EEG, echocardiogram, MRI, tilt test