ADD-ONS / OTHER VASCULAR DISORDERS

Created 09/12/2021, last revision 29/04/2023

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 last for several minutes or hours
• drop attacks are more common in older patients

Pathophysiology

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

Etiology

Differential diagnosis

• epilepsy
  • disturbance of consciousness, seizures other than those listed above
    
• narcolepsy
• cardiovascular syncope
  • a sudden, transient loss of consciousness and postural tone (brief loss of consciousness may go unnoticed)
  • many syncopal patients may have loss of tone and fall as part of the presyncope phase ⇒ therefore, always carefully exclude syncope (especially cardiovascular syncope)  [Dey, 1997]
• fall due to tripping, slipping, etc.