Timothy C. Hain, MD, Page last modified: March 27, 2015
Drop attacks are sudden spontaneous falls while standing or walking, with complete recovery in seconds or minutes. There is usually no recognized loss of consciousness and the event is remembered. It is a symptom, not a diagnosis, and it can have diverse causes. Sheldon (1960) reported that drop accounts accounted for about 1/4 of 500 consecutive falls in older patients. This estimate seems a bit high to us. Nevertheless, drop attacks are a very serious problem.
CAUSES OF DROP ATTACKS
In most instances (64%), the cause of the drop attack is never definitively established (Meissner et al, 1986). About 12% are due to the heart (a variant of syncope), 8% due to poor circulation to the brain, 8% due to problems with both the heart and brain, 7% due to seizures, 5% due to the inner ear (Menieres disease -- called the otolithic crisis of Tumarkin), and 1%, due to psychological problems. Rarely, drop attacks are exaggerated startle reactions.
In our practice at Chicago Dizziness and Hearing, most drop attacks are due to Meniere's disease, presumably because of the large number of patients that we follow with this condition. Then patients describe a sensation as if they are suddenly in free fall, they desparately try to right themselves, and end up on the floor. Variants include "invisible hands", or "shoves" with nobody around to push. Injuries are very common. Drop attacks from Meniere's are more "active" -- the person involved actually ends up participating in the fall (because they feel as if they are flipped). Most other drop attacks are slower and are more of a "collapse" than an actively driven fall. The mechanism for drop attacks in Meniere's is likely a "popping" of a dimpled inner ear membrane as pressure changes in the ear.
A small number of drop attacks may be due to SCD (superior canal dehiscence syndrome) (Brandtberg et al, 2005) . As we have never seen this in our substantial SCD experience, we are dubious that they exist. It is difficult
DIAGNOSIS OF DROP ATTACKS
Of course, if you have no clue as to the origin of the drop attacks, you may have to check for all possibilities. It is possible to have no obvious cause of the drop attacks emerge, or several possibilities, In this case, good judgment and perhaps a mixture of several treatment options will need to be pursued.
RISK OF STROKE OR DEATH
The stroke rate in persons with drop attacks is 0.5%/year. This rate is not significantly different than the general population. Persons with drop attacks however do have far more fractures than the general population.
TREATMENT OF DROP ATTACKS
Drop attacks are very serious as they often result in falls and breakage of bones. Treatment is individualized according to the diagnosis. Because in many instances, no diagnosis is established, no treatment may be advocated.
|Cause of Drop Attack||Most effective treatment|
|Cardiac disorders||Medication or pacemaker|
|Poor blood flow to brain (TIA)||Lower cholesterol, blood thinners, surgery on arteries to open them up.|
|Superior canal Dehiscence||Plug or patch superior canal.|
|Meniere's disease||Surgery or medication to destroy labyrinth (especially low dose gentamicin)|
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