ADD-ONS / OTHER VASCULAR DISORDERS

Drop Attack

Created 22.10.2020, last update 23.10.2021

Introduction

  • drop attack is a symptom, not a diagnostic unit
  • defined as a sudden fall while standing or walking, without accompanying loss of consciousness
    • differentiate from syncope, where often prodromes and especially a brief disturbance of consciousness are present (but both may escape attention)
  • weakness may persist for several minutes or hours
  • more common in elderly patients, a frequent cause of accidents

Pathophysiology

  • sudden and transient loss of muscle tone (cataplexy, atonic seizures, etc.)
  • hypertonus and freezing with postural dysbalance (Parkinsonian syndromes)
  • cerebellar-vestibular disorders (m.Menier)
  • neuromuscular disorders
  • joint disorders

Etiology

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Differencial diagnosis

  • epilepsy
    • disturbance of consciousness, seizures different from those stated above
  • cardiovascular syncope
    • a sudden, transient loss of consciousness and postural tone (short loss of consciousness may escape the attention)
    • many syncope patients may also have a loss of tone and fall as part of the presyncope state ⇒ therefore always carefully exclude syncope (especially cardiovascular syncope)  [Dey, 1997]
  • fall due to tripping, slipping, etc.
  • recurrent episodes of weakness, fatigue, and sudden sleep during the day when one should be awake
  • the quality of night sleep is impaired
    • the patient wakes frequently
    • REM sleep is disturbed
    • recurrent attacks of sleep paralysis may appear
  • cataplexy is common
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