Drop attack
Encyclopedia
Drop attacks are sudden spontaneous falls while standing
or walking
, followed by a very swift recovery, within seconds or minutes.
hypersensitivity, resulting in either short periods of reversible asystole
, or in marked drop in blood pressure
in response to carotid sinus
stimulation.
Other causes include the following:
Standing (position)
Standing is a human position in which the body is held upright and supported only by the feet, referred to as an orthostatic state.Although quiet standing appears to be static, modern instrumentation shows it to be a process of rocking from the ankle in the sagittal plane...
or walking
Walking
Walking is one of the main gaits of locomotion among legged animals, and is typically slower than running and other gaits. Walking is defined by an 'inverted pendulum' gait in which the body vaults over the stiff limb or limbs with each step...
, followed by a very swift recovery, within seconds or minutes.
Causes
Drop attacks are typically seen in elderly patients, and the most common cause is carotid sinusCarotid sinus
In human anatomy, the carotid sinus is a localized dilation of the internal carotid artery at its origin, the common carotid artery.-Functions:...
hypersensitivity, resulting in either short periods of reversible asystole
Asystole
In medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow...
, or in marked drop in blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
in response to carotid sinus
Carotid sinus
In human anatomy, the carotid sinus is a localized dilation of the internal carotid artery at its origin, the common carotid artery.-Functions:...
stimulation.
Other causes include the following:
- vascular - transient ischemic attackTransient ischemic attackA transient ischemic attack is a transient episode of neurologic dysfunction caused by ischemia – either focal brain, spinal cord or retinal – without acute infarction...
, cerebrovascular accident, dissection, occlusion, hemorrhage- intracranial hematoma
- posterior circulation infarctionInfarctionIn medicine, infarction refers to tissue death that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply. The resulting lesion is referred to as an infarct.-Causes:...
, emboli, vasospasm - bilateral anterior circulation occlusion
- migraineMigraineMigraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
accompagnee - develop over 1hr with assoc paresthesiaParesthesiaParesthesia , spelled "paraesthesia" in British English, is a sensation of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep"...
, HA - basilar arteryBasilar arteryIn human anatomy, the basilar artery is one of the arteries that supplies the brain with oxygen-rich blood.The two vertebral arteries and the basilar artery are sometimes together called the vertebrobasilar system, which supplies blood to the posterior part of circle of Willis and anastomoses with...
insuff - older pt with no LOC, transient loss of LE tone
- epilepsyEpilepsyEpilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
/paroxysmal- neurally mediated syncope - 75% of all causes
- Atonic seizureAtonic seizureAtonic seizures , are a type of seizure. They consist of a brief lapse in muscle tone that are caused by temporary alterations in brain function. The seizures are brief - usually less than fifteen seconds. They begin in childhood and may persist into adulthood...
- Lennox-Gastaut syndromeLennox-Gastaut syndromeLennox–Gastaut syndrome , also known as Lennox syndrome, is a difficult-to-treat form of childhood-onset epilepsy that most often appears between the second and sixth year of life, and is characterized by frequent seizures and different seizure types; it is often accompanied by developmental delay...
- atonic, myoclonic, GTC typically in neuro abnormal pt - Juvenile Myoclonic EpilepsyJuvenile myoclonic epilepsyJuvenile myoclonic epilepsy , also known as Janz syndrome, is a fairly common form of idiopathic generalized epilepsy, representing 5-10% of all epilepsies. This disorder typically first manifests itself between the ages of 12 and 18 with myoclonus occurring early in the morning. Most patients also...
- fall with myoclonusMyoclonusMyoclonus is brief, involuntary twitching of a muscle or a group of muscles. It describes a medical sign and, generally, is not a diagnosis of a disease. Brief twitches are perfectly normal. The myoclonic twitches are usually caused by sudden muscle contractions; they also can result from brief... - cataplexyCataplexyCataplexy is a sudden and transient episode of loss of muscle tone, often triggered by emotions. It is a rare disease , but affects roughly 70% of people who have narcolepsy...
associated with narcolepsyNarcolepsyNarcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia... - periodic paralyses
- complex partial seizureComplex partial seizureA complex partial seizure is an epileptic seizure that is associated with bilateral cerebral hemisphere involvement and causes impairment of awareness or responsiveness, i.e. loss of consciousness.-Presentation:...
- breath holding spells - associate pallor/cyanosisCyanosisCyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. The onset of cyanosis is 2.5 g/dL of deoxyhemoglobin. The bluish color is more readily apparent in those with high hemoglobin counts than it is...
, emotional aspect - pure autonomic failurePure autonomic failurePure autonomic failure, also known as Bradbury-Eggleston syndrome or idiopathic orthostatic hypotension, is a form of dysautonomia that first occurs in middle age or later in life; men are affected more often than women...
(Riley Day, long standing DM) - episodic ataxiaEpisodic ataxiaEpisodic ataxia is an autosomal dominant disorder characterized by sporadic bouts of ataxia with or without myokymia . There are seven types recognised but the majority are due to two recognized entities. Ataxia can be provoked by stress, startle, or heavy exertion such as exercise. Symptoms can...
- Panayiotopoulos syndromePanayiotopoulos syndromePanayiotopoulos syndrome is a common idiopathic childhood-related seizure disorder that occurs exclusively in otherwise normal children and manifests mainly with autonomic epileptic seizures and autonomic status epilepticus. An expert consensus has defined Panayiotopoulos syndrome as "a benign...
- degenerative
- postural instability with Parkinsons
- structural
- chronic odontoid instability
- spinal cord trauma with transient paraplegiaParaplegiaParaplegia is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek: παραπληγίη "half-striking". It is usually the result of spinal cord injury or a congenital condition such as spina bifida that affects the neural elements of the spinal canal...
- brainstem mass
- metabolic
- hypoglycemiaHypoglycemiaHypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...
, hypocalcemia, HypomagnesemiaHypomagnesemiaHypomagnesemia is an electrolyte disturbance in which there is an abnormally low level of magnesium in the blood. Usually a serum level less than 0.7 mmol/L is used as reference. The prefix hypo- means low . The middle 'magnes' refers to magnesium... - toxins, drugsDRUGSDestroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...
- cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, sedatives, antihistamineAntihistamineAn H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
, TCA
- hypoglycemia
- cardiac
- prolonged QT, tachycardiaTachycardiaTachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
, bradycardiaBradycardiaBradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...
, sick sinus syndromeSick sinus syndromeSick sinus syndrome, also called sinus node dysfunction, is a group of abnormal heart rhythms presumably caused by a malfunction of the sinus node, the heart's primary pacemaker...
, arrhythmia, IHSS. AS - hypovolemiaHypovolemiaIn physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma...
- prolonged QT, tachycardia
- psychiatric
- malingering, conversion, panicPanicPanic is a sudden sensation of fear which is so strong as to dominate or prevent reason and logical thinking, replacing it with overwhelming feelings of anxiety and frantic agitation consistent with an animalistic fight-or-flight reaction...
, anxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
- malingering, conversion, panic
- labirynth idropsy: an overflow of endolymph in ear labirynth causes distortions and breaks; see also Ménière's syndrome
Diagnosis
- important if there was an inciting event (NMS, breatholding, postural), any LOC, and presence of postictal pd
- initially get glucoseGlucoseGlucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...
, EKG, pregnancyPregnancyPregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
test, Utox, CT headComputed tomographyX-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
, lytes - later consider EEGEEGEEG commonly refers to electroencephalography, a measurement of the electrical activity of the brain.EEG may also refer to:* Emperor Entertainment Group, a Hong Kong-based entertainment company...
, echocardiogram, MRI, tilt testTilt table testA tilt table test, occasionally called upright tilt testing, is a medical procedure often used to diagnose dysautonomia or syncope. Patients with symptoms of dizziness or lightheadedness, with or without a loss of consciousness , suspected to be associated with a drop in blood pressure or...