ADD-ONS / OTHER VASCULAR DISORDERS

Drop Attack

Created 09/12/2021, last revision 24/01/2023

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

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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.
  • recurrent episodes of weakness, fatigue, and sudden falling asleep during the day
  • quality of night sleep is impaired
    • patient wakes frequently
    • REM sleep is disturbed
    • recurrent episodes of sleep paralysis may occur
  • cataplexy is common
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Drop attack
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