Drop attack: Difference between revisions

Revision as of 21:30, 7 April 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farman Khan, MD, MRCP [2]

Overview

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

Causes

Causes of drop attacks include.

Vascular - transient ischemic attack, cerebrovascular accident, dissection, occlusion, hemorrhage
- Intracranial hemorrhage
- Posterior circulation infarction, emboli, vasospasm
- Bilateral anterior circulation occlusion
- Migraine - develop over 1hr with assoc paresthesia, HA
- Basilar artery insuff - older pt with no LOC, transient loss of LE tone
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
- Breatholding spells - associate pallor/cyanosis, emotional aspect
- Pure autonomic failure (Riley Day, long standing DM)
- Episodic ataxia
- Panayiotopoulos syndrome
Degenerative
- Postural instability with Parkinsons
Structural
- Chronic odontoid instability
- Spinal cord trauma with transient paraplegia
- Brainstem mass
metabolic
- Hypoglycemia, hypocalcemia, Hypomagnesemia
- Toxins, drugs - cocaine, sedatives, antihistamine, TCA
Cardiac
- Prolonged QT, tachycardia, bradycardia, sick sinus syndrome, arhythmia, IHSS. AS
- Hypovolemia
Psychologic
- Malingering, conversion, panic, anxiety

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 by Organ System

Cardiovascular	Cardiac arrest, bradycardia, prolonged QT, sick sinus syndrome, Stokes-Adams attacks, tachycardia, ventricular tachycardia, aortic stenosis
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Sedatives, antihistamine, tricyclic antidepressants
Ear Nose Throat	No underlying causes
Endocrine	Hypoglycemia
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	Astatic seizure , Episodic ataxia , Juvenile myoclonic epilepsy , Migraine , Myoclonic seizure , Panayiotopoulos syndrome Parkinsons , Pure autonomic failure , Seizure , Verterbrobasilar artery insufficiency , Paraplegia, Brain stem mass
Nutritional / Metabolic	Hypoglycemia, hypocalcemia, hypomagnesemia
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	Cocaine
Psychiatric	Malingering, conversion, panic attack, anxiety
Pulmonary	Sleep apnea
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in alphabetical order

Anaphylaxis
Antihistamines
Aortic stenosis
Astatic seizure
Bradycardia
Brain stem mass
Breath holding spells
Cardiac arrest
Cardiac syncope
Cardiac tamponade
Cocaine
Conversion disorders
Episodic ataxia
Gout
Hypocalcemia
Hypoglycemia
Hypokalemic periodic paralysis
Hypomagnesemia
Juvenile myoclonic epilepsy
Lennox-Gastaut Syndrome - drop attacks
Malingering
Migraine
Myoclonic seizure
Panayiotopoulos syndrome
Parkinsons disease
Paraplegia
Panic attack
Panic disorder
Prolonged QT
Pure autonomic failure
Sedatives
Seizures
Sick sinus syndrome
Sleep apnea
Spinal cord trauma
Stokes-Adams attacks
Superior canal dehiscence syndrome
Tachycardia
Trypanophobia
Ventricular tachcardia
Verterbrobasilar artery insufficiency

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

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 ==Overview==
@@ Line 21: / Line 7: @@
 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:
+==Causes==
+Causes of drop attacks include.
-# vascular - [[transient ischemic attack]], [[cerebrovascular accident]], dissection, occlusion, [[hemorrhage]]
+# Vascular - [[transient ischemic attack]], [[cerebrovascular accident]], dissection, occlusion, [[hemorrhage]]
-#* intracranial hemm
+#* Intracranial hemorrhage
-#* posterior circulation [[infarction]], emboli, vasospasm
+#* Posterior circulation [[infarction]], emboli, vasospasm
-#* bilateral anterior circulation occlusion
+#* Bilateral anterior circulation occlusion
-#* [[migraine]] accompagnee - develop over 1hr with assoc [[paresthesia]], HA
+#* [[Migraine]] - develop over 1hr with assoc [[paresthesia]], HA
-#* [[basilar artery]] insuff - older pt with no LOC, transient loss of LE tone
+#* [[Basilar artery]] insuff - older pt with no LOC, transient loss of LE tone
-# [[epilepsy]]/paroxysmal
+# [[Epilepsy]]/paroxysmal
-#* neurally mediated syncope - 75% of all causes
+#* Neurally mediated syncope - 75% of all causes
 #* [[Myoclonic seizure]], astatic seizure, or [[Absence seizure|petit mal syndrome]]
 #* Lennox Gaustaut - atonic, myoclonic, GTC typically in neuro abnormal pt
 #* [[Juvenile myoclonic epilepsy|Juvenile Myoclonic Epilepsy]] - fall with [[myoclonus]]
-#* laugh or cough triggered [[epilepsy]]
+#* Laugh or cough triggered [[epilepsy]]
-#* [[cataplexy]] associated with [[narcolepsy]]
+#* [[Cataplexy]] associated with [[narcolepsy]]
-#* periodic [[paralysis]]
+#* Periodic [[paralysis]]
-#* [[complex partial seizure]]
+#* [[Complex partial seizure]]
-#* reatholding spells - associate pallor/[[cyanosis]], emotional aspect
+#* Breatholding spells - associate pallor/[[cyanosis]], emotional aspect
-#* [[pure autonomic failure]] (Riley Day, long standing DM)
+#* [[Pure autonomic failure]] (Riley Day, long standing DM)
-#* [[episodic ataxia]]
+#* [[Episodic ataxia]]
 #* Panayiotopoulos syndrome
-# degenerative
+# Degenerative
-#* postural instability with [[Parkinsons]]
+#* Postural instability with [[Parkinsons]]
-# structural
+# Structural
-#* chronic odontoid instability
+#* Chronic odontoid instability
-#* [[spinal cord trauma]] with transient [[paraplegia]]
+#* [[Spinal cord trauma]] with transient [[paraplegia]]
-#* [[brainstem]] mass
+#* [[Brainstem]] mass
 # metabolic
-#* [[hypoglycemia]], [[hypocalcemia]], [[Hypomagnesemia]]
+#* [[Hypoglycemia]], [[hypocalcemia]], [[Hypomagnesemia]]
-#* [[toxins]], [[drugs]] - [[cocaine]], [[sedatives]], [[antihistamine]], TCA
+#* [[Toxins]], [[drugs]] - [[cocaine]], [[sedatives]], [[antihistamine]], TCA
-# [[cardiac]]
+# [[Cardiac]]
-#* prolonged QT, [[tachycardia]], [[bradycardia]], [[sick sinus syndrome]], [[Cardiac arrhythmia|arhythmia]], IHSS. AS
+#* Prolonged QT, [[tachycardia]], [[bradycardia]], [[sick sinus syndrome]], [[Cardiac arrhythmia|arhythmia]], IHSS. AS
-#* [[hypovolemia]]
+#* [[Hypovolemia]]
-# psych
+# Psychologic
-#* malingering, conversion, [[panic]], [[anxiety]]
+#* Malingering, conversion, [[panic]], [[anxiety]]
 ==Common causes==