DROP ATTACKS

DROP ATTACKS: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the following questions:

1. Is there loss of consciousness? If there is loss of consciousness, the differential diagnosis for syncope should be considered.
2. Are there other neurologic signs and symptoms? Focal neurologic signs and symptoms should make one think of basilar artery insufficiency, cerebral arteriosclerosis, Ménière's disease, and cerebellar atrophy. A brain tumor should also be considered if there are focal signs.
3. Is there hypotension, cardiomegaly, or a heart murmur? These findings should make one think of orthostatic hypotension, aortic stenosis and insufficiency, and cardiac arrhythmia.

DIAGNOSTIC WORKUP

Basic studies for the workup of drop attacks are CBC, sedimentation rate, chemistry panel, VDRL test, chest x-ray, and EKG. These will help identify anemia, hypoglycemia, and cardiovascular diseases. An EEG should also be done to rule out epilepsy. If there are focal neurologic signs, a CT scan or MRI should be done. Remember, the MRI is double the cost and the diagnostic yield is only slightly higher. A neurologist should be consulted to help decide which study is appropriate. A 5-hr glucose tolerance test can be done to help diagnose hypoglycemia. Four-vessel angiography is necessary to diagnose vertebral basilar disease. Holter monitoring will be useful to diagnose complete heart block and other cardiac arrhythmias. If the chest x-ray or EKG has revealed possible cardiac findings, a referral to a cardiologist would be wise.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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