Drop attack: Difference between revisions
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Causes of drop attacks include: | Causes of drop attacks include: | ||
# [[Vascular]] - [[transient ischemic attack]], [[cerebrovascular accident]], [[dissection]], [[occlusion]], [[hemorrhage]] | # '''[[Vascular]]''' - [[transient ischemic attack]], [[cerebrovascular accident]], [[dissection]], [[occlusion]], [[hemorrhage]] | ||
#* [[Intracranial hemorrhage]] | #* [[Intracranial hemorrhage]] | ||
#* [[Posterior circulation infarct|Posterior circulation infarction]], [[emboli]], [[vasospasm]] | #* [[Posterior circulation infarct|Posterior circulation infarction]], [[emboli]], [[vasospasm]] | ||
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#* [[Migraine]] - develops over 1 hour, with associated [[paresthesia]], ''[[Hypertonia]] arterialis'' | #* [[Migraine]] - develops over 1 hour, with associated [[paresthesia]], ''[[Hypertonia]] arterialis'' | ||
#* [[Basilar artery insufficiency]] - older [[patient]] with no [[loss of consciousness]], [[transient]] loss of LE tone | #* [[Basilar artery insufficiency]] - older [[patient]] with no [[loss of consciousness]], [[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]], [[Idiopathic generalized epilepsy|myoclonic-astatic seizure]], or [[Absence seizure|petit mal syndrome]] | #* [[Myoclonic seizure]], [[Idiopathic generalized epilepsy|myoclonic-astatic seizure]], or [[Absence seizure|petit mal syndrome]] | ||
| Line 29: | Line 29: | ||
#* [[Episodic ataxia]] | #* [[Episodic ataxia]] | ||
#* Panayiotopoulos syndrome | #* 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]] | ||
# Psychologic | # '''Psychologic''': | ||
#* Malingering, conversion, [[panic]], [[anxiety]] | #* Malingering, conversion, [[panic]], [[anxiety]] | ||
Revision as of 01:55, 9 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 - develops over 1 hour, with associated paresthesia, Hypertonia arterialis
- Basilar artery insufficiency - older patient with no loss of consciousness, transient loss of LE tone
- Epilepsy/paroxysmal:
- Neurally mediated syncope - 75% of all causes
- Myoclonic seizure, myoclonic-astatic seizure, or petit mal syndrome
- Lennox-Gastaut syndrome - atonic seizure, myoclonic seizure, Generalized tonic-clonic seizure typically occurring in neurologically abnormal patients
- Juvenile Myoclonic Epilepsy - fall with myoclonus
- Laugh or cough triggered epilepsy
- Cataplexy associated with narcolepsy
- Periodic paralysis
- Complex partial seizure
- Breath-holding spells - associated pallor/cyanosis, emotional related
- Pure autonomic failure (Riley-Day Syndrome, long standing diabetes mellitus)
- Episodic ataxia
- Panayiotopoulos syndrome
- Degenerative:
- Structural:
- Chronic odontoid instability
- Spinal cord trauma with transient paraplegia
- Brainstem mass
- Metabolic:
- Cardiac:
- Prolonged QT, tachycardia, bradycardia, sick sinus syndrome, arhythmia, IHSS. AS
- Hypovolemia
- Psychologic:
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 | |
| 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