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 falling 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.

DROP ATTACKS

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 the elderly 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 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

1. ECG (cardiac arrhythmia)
2. MRI of the brain (basilar artery insufficiency)
3. Magnetic resonance angiography (orthostatic hypotension)
4. 24-hour blood pressure monitoring (hypotension)
5. Five-hour glucose tolerance test (hypoglycemia).

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 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: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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