Cryptogenic drop attacks: an affliction of women

A drop attack was defined as falling without warning, not apparently due to any malfunction of the legs, not induced by change of posture or movement of the head, and not accompanied by vertigo or other cephalic sensation. All 33 patients attending a neurological clinic with a primary complaint fulfilling these criteria were women, and a further seven examples were found by questioning 200 consecutive patients at a gynaecological clinic. No affected male was found.In all but one patient, falls occurred only when walking. They were not due to wearing high-heeled shoes. The average age at onset was 44.5 years and in younger women onset was often during pregnancy. The accepted causes of drop attacks were not found with certainty in any of these patients. The sex incidence and the circumstances of the falls suggest that the cause may lie in differences between the two sexes in the mechanism of walking rather than in any central disturbance. Drop attacks in women commonly occur as an isolated symptom for many years, and although distressing have no serious prognostic implications.