DROP ATTACKS
DROP ATTACKS: Excerpt from Differential Diagnosis in Primary Care
In drop attacks, the patient, usually elderly, experiences the sudden
giving away of his or her legs and falls to the floor without loss of
consciousness. The fact that the patient remains conscious distinguishes
drop attacks from syncope or the vasovagal attack and epilepsy.
Nevertheless, these attacks result from a temporary decrease in blood supply
to centers in the brainstem responsible for muscle tone. Consequently, we
can develop a differential diagnosis by following the arterial tree from the
heart to the brainstem.
Heart. A coronary thrombosis and cardiac arrhythmias may
cause drop attacks.
Aorta. Aortic stenosis and insufficiency may be the cause
of recurring drop attacks.
Arteries. Focusing on the arteries in general we can recall
orthostatic hypotension either related to drugs, anemia, or idiopathic type.
Vertebral–basilar arteries. Atherosclerotic narrowing of
these arteries leads to transient cerebral ischemia and drop attacks.
This leaves a few conditions that may simulate drop attacks in elderly
persons such as weak quadriceps muscles, poor vision, postural instability
from posterior column degeneration, and tripping over unseen objects.
Approach to the Diagnosis
Basic workup includes a CBC, chemistry panel, urinalysis, carotid
doppler study, and electrocardiogram (ECG). The clinical picture and
neurologic or cardiology consult will help determine if Holter monitoring or
four-vessel cerebral angiography should be done.
Other Useful Tests
-
ECG (cardiac arrhythmia)
- MRI of the brain (basilar artery insufficiency)
- Magnetic resonance angiography (orthostatic hypotension)
- 24-hour blood pressure monitoring (hypotension)
- Five-hour glucose tolerance test (hypoglycemia)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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