Drop Attacks

by Timothy C. Hain, MD

Last updated 10/2012

What are Drop Attacks?

Drop attacks are sudden spontaneous falls while standing or walking, with complete recovery in seconds or minutes. There is usually no recognized loss of consciousness, and the event is remembered. It is a symptom, not a diagnosis, and it can have diverse causes.

The stroke rate in persons with drop attacks is only 0.5% per year. This rate is not significantly different than the general population.

What Causes Drop Attacks?

In most instances, the cause of the drop attack is never definitively established (Meissner et al, 1986). About 12% are due to the heart (a variant of syncope), 8% are due to poor circulation to the brain, 8% are due to problems with both the heart and brain, 7% are due to seizures, 5% are due to the inner ear (Meniere’s disease — called the otolithic crisis of Tumarkin), and 1%, are due to psychological problems. Other causes of drop attacks include medications and gait imbalances (Lee 2005). Patients with Meniere’s disease who experience drop attacks have shown more severe autonomic symptoms and may present with poor hearing in the “unaffected” ear (Perez-Fernandez, 2010).

A study of 10 patients with drop attacks found 8 of them to have abnormal blood vessels in the neck or head (Welsh 2004). This suggests that abnormal or diseased arteries may be the cause of drop attacks in some patients, or may predispose patients with other cardiovascular problems to having drop attacks. A case study of six patients who had drop attacks found five of them to have migraines or a family history of migraines (Ishiyama 2003). The significance of this finding is not currently established.

How are Drop Attacks Diagnosed?

Drop attacks due to the heart are similar to brief fainting episodes. They are best diagnosed with event monitoring. Drop attacks due to seizures and related problems are diagnosed with an EEG test and its variants. Drop attacks due to Meniere’s disease (also called Otolithic Crises of Tumarkin) are diagnosed with an audiogram and ENG. Patients with Meniere’s disease with drop attacks have abnormal vestibular evoked myogenic potential (VEMP) exams compared to patients who do not have drop attacks (Timmer 2006).

A variety of other tests may also be performed. Drop attacks due to psychological problems are very difficult to confirm, but sometimes can be established via inpatient EEG monitoring.

How are Drop Attacks Treated?

Treatment is individualized according to the diagnosis. Because, in many instances, no diagnosis is established, no treatment may be advocated.

References

  • Baloh RW, Jacobson K, Winder T. Drop attacks with Meniere’s syndrome. Ann Neurol 1990:28:384-87
  • Black FL, Effron MZ, Burns DS. Diagnosis and management of drop attacks of vestibular origin: Tumarkin’s otolithic crises. J. Otolaryngol HNS 1982:90:256-262
  • Brust JCM, Plank CR, Healton EB, Sanchez GF. The pathology of drop attacks: a case report. Neurology 29, 786-790, 1979
  • Janzen VD, Russel RD. Conservative management of Tumarkin’s otolithic crisis. Canad. J. Otol, 1988
  • Ishiyama G, Ishiyama A, Baloh RW. Drop attacks and vertigo secondary to a non-meniere otologic cause. Arch Neuro. 60(1):71-5, 2003.
  • Li H, Yi HA et al. Drop attacks in elderly patients secondary to otologic causes with Meniere’s syndrome or non-Meniere peripheral vestibulopathy. J Neuro Sci. 232(1-2):71-6, 2005.
  • Meissner et al. The natural history of drop attacks. Neurology 1986, 36, 1029-1034
  • Odkvist LM, Bergenius J. Drop attacks in Meniere’s disease. Acta Otolaryngol Supp 1988:455: 82-85
  • Perez-Fernandez N, Montes-Jovellar L, Cervera-Paz J, Domenech-Vadillo E. 2010. Auditory and vestibular assessment of patients with Meniere’s disease who suffere Tumarkin attacks. Audiology & nuerolo-otology 15: 399-406
  • Timmer FC, Zhou G et al. Vestibular evoked myogenic potential (VEMP) in patients with Meniere’s disease with drop attacks. Laryngoscope. 116(5):776-9, 2006.
  • Welsh LW, Welsh JJ et al. Vascular analysis of individuals with drop attacks. Ann Oto. Rhino Laryng. 113(3 pt 1):245-51, 2004