Drop attack

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farman Khan, MD, MRCP [2]


Drop attacks are sudden spontaneous falls while standing or walking, followed by a very swift recovery, within seconds or minutes. Drop attacks are typically seen in elderly patients, and the most common cause is carotid sinus hypersensitivity, resulting in either short periods of reversible asystole, or in marked drop in blood pressure in response to carotid sinus stimulation. Drop attacks are differnetiated from vaso-vagal and other causes of syncope due to the characteristic feature of drop attack that is a sudden feeling of being pulled or pushed towards the ground without any loss of consciousness.


Causes of drop attacks include:

  1. Vascular - transient ischemic attack, cerebrovascular accident, dissection, occlusion and hemorrhage
  2. Epilepsy/paroxysmal:
  3. Degenerative disease:
  4. Structural:
  5. Metabolic:
  6. Cardiac:
  7. Psychologic:

Common Causes

Causes by Organ System

Cardiovascular Cardiac arrest, Bradycardia, Prolonged QT, Sick Sinus Syndrome, Stokes-Adams attacks, Tachycardia, Ventricular Tachycardia, Aortic Stenosis, Cardiac Syncope, Cardiac tamponade, Vertebrobasilar Artery Insufficiency
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Sedatives, Antihistamine, Tricyclic antidepressants
Ear Nose Throat Superior canal dehiscence syndrome
Endocrine Hypoglycemia, Hypocalcemia
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic Gout
Iatrogenic Antihistamines, Sedatives
Infectious Disease No underlying causes
Musculoskeletal / Ortho Gout, Paraplegia, Spinal cord trauma
Neurologic Astatic seizure, Episodic ataxia, Juvenile myoclonic epilepsy, Migraine, Myoclonic seizure, Panayiotopoulos syndrome

Parkinsons, Pure autonomic failure, Seizure, Vertebrobasilar artery insufficiency, Paraplegia, Brain stem mass, Breath-holding spells, Conversion disorder, Episodic ataxia, Hypokalemic periodic paralysis, Lennox-Gastaut Syndrome, Superior canal dehiscence syndrome

Nutritional / Metabolic Hypoglycemia, Hypocalcemia, Hypomagnesemia, Gout, Hypomagnesemia
Obstetric/Gynecologic No underlying causes
Oncologic Brain stem mass
Opthalmologic No underlying causes
Overdose / Toxicity Cocaine, Sedatives
Psychiatric Malingering, Conversion disorder, Panic attack, Anxiety, Panic disorder, Trypanophobia
Pulmonary Sleep apnea
Renal / Electrolyte Hypocalcemia, Hypomagnesemia
Rheum / Immune / Allergy Anaphylaxis
Sexual No underlying causes
Trauma Spinal cord trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Sleep apnea

Causes in alphabetical order


  1. Glucose
  2. EKG
  3. Pregnancy test
  4. Urine toxicology test
  5. CT head
  6. Electrolytes
  7. Later consider: EEG, Echocardiogram, MRI and Tilt test

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