Drop attack

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Drop attacks are sudden spontaneous falls while standing or walking, followed by a very swift recovery, within seconds or minutes. This phenomena is usually caused by a temporary drop in blood supply to the anterior lobe of the cerebellum (anterior vermis). Similar to a 'faint' episode without loss of consciousness.

See also: Atonic seizure


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.

Other causes include the following:

  1. vascular - transient ischemic attack, cerebrovascular accident, dissection, occlusion, hemorrhage
    • intracranial hematoma
    • posterior circulation infarction, emboli, vasospasm
    • bilateral anterior circulation occlusion
    • migraine accompagnee - develop over 1 hour with associated paresthesia and headache
    • basilar artery insuff - occurs in older patients, with no loss of consciousness, transient loss of lower extremity tone
  2. epilepsy/paroxysmal
  3. degenerative
  4. structural
  5. metabolic
  6. cardiac
  7. psychiatric
  8. labyrinth hydrops: an overflow of endolymph in ear labyrinth causes distortions and breaks; see also Ménière's syndrome