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Drop attacks: a practical guide

Evelyn Manford1, Anupam Garg2, Mark Manford3

  • 1Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Practical Neurology
|October 27, 2023
PubMed

Insights

Drop attacks, often undefined, include falls and transient loss of consciousness. Cardiovascular issues are common, but vestibular dysfunction, epilepsy, and functional disorders also cause collapses, requiring comprehensive diagnosis.

Area of Science:

  • Neurology
  • Cardiology
  • Geriatrics

Background:

  • The term 'drop attacks' lacks a clear definition, encompassing both falls and transient loss of consciousness.
  • Understanding the diverse etiologies of drop attacks is crucial for accurate diagnosis and management.
  • Elderly individuals often present with multifactorial fall risks, complicating diagnosis.

Approach:

  • This review defines 'drop attacks' and explores differential diagnoses, focusing on common and rarer causes.
  • Clinical and electrographic criteria for identifying cardiac disorders, such as arrhythmias, are discussed.
  • The approach considers the interplay of cardiovascular issues, vestibular dysfunction, epilepsy, functional neurological disorders, and frailty.

Key Points:

  • Cardiovascular conditions are the most frequent cause of drop attacks.
  • Vestibular dysfunction can precipitate collapses, sometimes without vertigo, and may coexist with cardiac issues in the elderly.
  • Epilepsy, functional neurological disorders, and rarer conditions like cataplexy and hydrocephalic attacks are also considered.

Conclusions:

  • A comprehensive diagnostic strategy is essential for 'drop attacks', moving beyond a singular cause.
  • Identifying 'worrying syncopes' of cardiac origin requires specific clinical and electrographic evaluation.
  • Assessment in the elderly should integrate frailty and multifactorial risk factors alongside specific etiological investigations.

Keywords:
CLINICAL NEUROLOGYCONSCIOUSNESSEPILEPSYGAIT

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