Drop attack: Difference between revisions
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{|style="width:80%; height:100px" border="1" | {|style="width:80%; height:100px" border="1" | ||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | ||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Cardiac arrest]], [[bradycardia]], [[prolonged QT]], [[sick sinus syndrome]], [[Stokes-Adams attacks]], [[tachycardia]], [[ventricular tachycardia]], [[aortic stenosis]] | |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Cardiac arrest]], [[bradycardia]], [[prolonged QT]], [[sick sinus syndrome]], [[Stokes-Adams attacks]], [[tachycardia]], [[ventricular tachycardia]], [[aortic stenosis]], [[Cardiac]] [[syncope]], [[Cardiac tamponade]] | ||
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| '''Endocrine''' | | '''Endocrine''' | ||
|bgcolor="Beige"| [[Hypoglycemia]] | |bgcolor="Beige"| [[Hypoglycemia]], [[Hypocalcemia]] | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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| '''Hematologic''' | | '''Hematologic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Gout]] | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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| '''Musculoskeletal / Ortho''' | | '''Musculoskeletal / Ortho''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Gout]], [[Paraplegia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Neurologic''' | | '''Neurologic''' | ||
|bgcolor="Beige"| [[Idiopathic generalized epilepsy|Astatic seizure]] , [[Episodic ataxia]] , [[Juvenile myoclonic epilepsy]] , [[Migraine]] , [[Myoclonic seizure]] , Panayiotopoulos syndrome | |bgcolor="Beige"| [[Idiopathic generalized epilepsy|Astatic seizure]], [[Episodic ataxia]], [[Juvenile myoclonic epilepsy]], [[Migraine]], [[Myoclonic seizure]], Panayiotopoulos syndrome | ||
[[Parkinsons]] , [[Pure autonomic failure]] , [[Seizure]] , [[Vertebrobasilar insufficiency|Vertebrobasilar artery insufficiency]] , [[Paraplegia]], [[Brain stem]] [[mass]] | [[Parkinsons]], [[Pure autonomic failure]], [[Seizure]], [[Vertebrobasilar insufficiency|Vertebrobasilar artery insufficiency]], [[Paraplegia]], [[Brain stem]] [[mass]], [[Breath-holding spells]], [[Conversion disorder]], [[Episodic ataxia]], [[Hypokalemic periodic paralysis]], [[Lennox-Gastaut Syndrome]] | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Nutritional / Metabolic''' | | '''Nutritional / Metabolic''' | ||
|bgcolor="Beige"| [[Hypoglycemia]], [[ | |bgcolor="Beige"| [[Hypoglycemia]], [[Hypocalcemia]], [[Hypomagnesemia]], [[Gout]], [[Hypomagnesemia]] | ||
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| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Brain stem]] [[mass]] | ||
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| '''Psychiatric''' | | '''Psychiatric''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Malingering]], [[Conversion disorder]], [[Panic attack]], [[Anxiety]], [[Panic disorder]] | ||
[[Malingering]], [[ | |||
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| '''Renal / Electrolyte''' | | '''Renal / Electrolyte''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Hypocalcemia]], [[Hypomagnesemia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" |
Revision as of 04:01, 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 and hemorrhage
- Intracranial hemorrhage
- Posterior circulation infarction, emboli and 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 lower extremity tone
- Epilepsy/paroxysmal:
- Neurally mediated syncope - 75% of all causes
- Myoclonic seizure
- Myoclonic-astatic seizure
- Petit mal syndrome
- Lennox-Gastaut syndrome - atonic seizure, myoclonic seizure and 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, emotion related
- Pure autonomic failure (Riley-Day Syndrome, long standing diabetes mellitus)
- Episodic ataxia
- Panayiotopoulos syndrome
- Degenerative disease:
- Structural:
- Chronic odontoid instability
- Spinal cord trauma with transient paraplegia
- Brainstem mass
- Metabolic:
- Cardiac:
- 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, Cardiac syncope, Cardiac tamponade |
Chemical / poisoning | No underlying causes |
Dermatologic | No underlying causes |
Drug Side Effect | Sedatives, antihistamine, tricyclic antidepressants |
Ear Nose Throat | No underlying causes |
Endocrine | Hypoglycemia, Hypocalcemia |
Environmental | No underlying causes |
Gastroenterologic | No underlying causes |
Genetic | No underlying causes |
Hematologic | Gout |
Iatrogenic | Antihistamines |
Infectious Disease | No underlying causes |
Musculoskeletal / Ortho | Gout, Paraplegia |
Neurologic | Astatic seizure, Episodic ataxia, Juvenile myoclonic epilepsy, Migraine, Myoclonic seizure, Panayiotopoulos syndrome
Parkinsons, Pure autonomic failure, Seizure, Vertebrobasilar artery insufficiency, Paraplegia, Brain stem mass, Breath-holding spells, Conversion disorder, Episodic ataxia, Hypokalemic periodic paralysis, Lennox-Gastaut Syndrome |
Nutritional / Metabolic | Hypoglycemia, Hypocalcemia, Hypomagnesemia, Gout, Hypomagnesemia |
Obstetric/Gynecologic | No underlying causes |
Oncologic | Brain stem mass |
Opthalmologic | No underlying causes |
Overdose / Toxicity | Cocaine |
Psychiatric | Malingering, Conversion disorder, Panic attack, Anxiety, Panic disorder |
Pulmonary | Sleep apnea |
Renal / Electrolyte | Hypocalcemia, Hypomagnesemia |
Rheum / Immune / Allergy | Anaphylaxis |
Sexual | No underlying causes |
Trauma | No underlying causes |
Urologic | No underlying causes |
Dental | No underlying causes |
Miscellaneous | No underlying causes |
Causes in alphabetical order
Diagnosis
- Important in the presence of an inciting event (Neuroleptic malignant syndrome, breatholding, postural), any loss of consciousness and presence of post-ictal period
- Initial tests:
- Glucose
- EKG
- Pregnancy test
- Urine toxicology test
- CT head
- Electrolytes
- Later consider EEG, echocardiogram, MRI and tilt test