# Drop attack

> Mediated Wiki article. Canonical URL: https://mediated.wiki/source/Drop_attack
> Markdown URL: https://mediated.wiki/source/Drop_attack.md
> Source: https://en.wikipedia.org/wiki/Drop_attack
> Source revision: 1318977944
> License: Creative Commons Attribution-ShareAlike 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/)

A **drop attack** is a sudden [fall](/source/Falling_(accident)) without [loss of consciousness](/source/Unconsciousness). A drop attack has been defined as "a collapse or fall with little warning, following which the patient lies motionless or nearly motionless for a variable time, but often with rapid recovery to their normal state".[1] However, the understanding of what constitutes a drop attack varies widely between authors.

Drop attacks stem from diverse mechanisms, including [orthopedic](/source/Orthopedic_surgery) causes (for example, [leg weakness](/source/Muscle_weakness) and [knee instability](/source/Joint_stability)), [hemodynamic](/source/Hemodynamics) causes (for example, transient [vertebrobasilar insufficiency](/source/Vertebrobasilar_insufficiency), a type of interruption of [blood flow](/source/Blood_flow) to the brain), and [neurologic](/source/Nervous_system) causes (such as [epileptic seizures](/source/Epileptic_seizure) or unstable [vestibular](/source/Vestibular_system) function).

The term "drop attack", also known as "cryptogenic drop attack" or "La maladie des genoux bleus";[2][3][4] is used to categorize otherwise unexplained falls from a wide variety of causes and is considered ambiguous medical terminology; drop attacks are currently reported much less often than in the past, possibly as a result of better [diagnostic](/source/Medical_diagnosis) precision.[5][6]

The common cardiovascular causes of drop attacks include [syncope](/source/Syncope_(medicine)) (a sudden transient loss of awareness due to reduced blood flow to the brain), [orthostatic hypotension](/source/Orthostatic_hypotension) (which is often precipitated by medications), and arrhythmias (abnormalities of the heart beat). A drop of [systolic](/source/Systole) [blood pressure](/source/Blood_pressure) more than 20 mm Hg or a drop in diastolic blood pressure more than 10 mm Hg can indicate [orthostatic hypotension](/source/Orthostatic_hypotension). Syncope following exertion may indicate structural heart defects like [hypertrophic cardiomyopathy](/source/Hypertrophic_cardiomyopathy) or [cardiac tumours](/source/Cardiac_tumour). While the majority of syncopal events are benign in nature, a drop attack could be a harbinger of a potentially lethal cardiac disorder like [Brugada syndrome](/source/Brugada_syndrome) or [long QT syndrome](/source/Long_QT_syndrome).[1] By definition, drop attacks exclude syncopal falls (fainting), which involve short loss of consciousness. Hence, a detailed cardiac evaluation, including [echocardiography](/source/Echocardiography) and [Holter study](/source/Holter_monitor) (a continuous [ECG monitoring](/source/ECG_monitor)) is recommended in drop attacks due to syncope.

In [neurology](/source/Neurology), the term "drop attack" is used to describe certain types of seizure which occur in [epilepsy](/source/Epilepsy).[7][8] Epileptic drop attacks are [atonic seizures](/source/Atonic_seizure) that can cause sudden, often injurious falls. These are commonly seen in severe childhood epilepsies like [Lennox–Gastaut syndrome](/source/Lennox%E2%80%93Gastaut_syndrome) and [Doose Syndrome](/source/Doose_Syndrome) as well as symptomatic focal epilepsies.[9] These are often difficult to treat and may need a combination of [antiseizure medications](/source/Antiseizure_medication) and/or non-pharmacological measures like [vagal nerve stimulation](/source/Vagal_nerve_stimulation) (VNS) or [corpus callosotomy](/source/Corpus_callosotomy) (transsection of the midline brain fibres).

Drop attacks that have a [vestibular](/source/Vestibular_system) origin within the [inner ear](/source/Inner_ear) may be experienced by some people in the later stages of [Ménière's disease](/source/M%C3%A9ni%C3%A8re's_disease) (these may be referred to as **Tumarkin drop attacks**, or as Tumarkin's [otolithic](/source/Otolithic_membrane) crisis).[10][11] These have been attributed to dysfunction of the [utricle](/source/Utricle_(ear)) and [saccule](/source/Saccule).

Drop attacks often occur in elderly people; with a majority of documented cases occurring in women.[4][12][2][3] Cardiac disorders are the most common cause of drop attacks in the elderly followed by disorders of gait and balance.[13] [Falls in older adults](/source/Falls_in_older_adults) happen for many reasons, and the goals of health care include preventing any preventable falls and correctly diagnosing any falls that do happen.

## References

1. Manford E, Garg A, Manford M. "[Drop attacks: a practical guide"](https://pn.bmj.com/content/24/2/106.long). *Practical Neurology*. 2024 Mar 19; 24(2):106-113. doi: 10.1136/pn-2023-003791. PMID: 37891001

1. Stevens, D. L. & Matthews, W. B. (1973-02-24). ["Cryptogenic Drop Attacks: An Affliction of Women"](https://www.bmj.com/content/1/5851/439). *Br Med J*. **1** (5851): 439–442. [doi:10.1136/bmj.1.5851.439](https://doi.org/10.1136/bmj.1.5851.439). [ISSN 0007-1447](https://www.worldcat.org/issn/0007-1447). [PMC 1588502](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1588502). [PMID 4689829](https://pubmed.ncbi.nlm.nih.gov/4689829)

1. Butsch, Raphael & Schneemann, Markus (2014-06-27). ["Two women with recurrent falls: La maladie des genoux bleus alias cryptogenic drop attacks"](https://casereports.bmj.com/content/2014/bcr-2013-200855). *Case Reports*. **2014**: bcr2013200855. [doi:10.1136/bcr-2013-200855](https://doi.org/10.1136/bcr-2013-200855). [ISSN 1757-790X](https://www.worldcat.org/issn/1757-790X). [PMC 4078483](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078483). [PMID 24973344](https://pubmed.ncbi.nlm.nih.gov/24973344)

1. Revell, Emily R.; Gillespie, David; Morris, Paul G.; Stone, Jon (2021-01-01). "Drop attacks as a subtype of FND: A cognitive behavioural model using grounded theory". *Epilepsy & Behavior Reports*. **16**. [doi:10.1016/j.ebr.2021.100491](https://doi.org/10.1016/j.ebr.2021.100491). [ISSN 2589-9864](https://www.worldcat.org/issn/2589-9864). [PMC 8550987](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8550987). [PMID 34746733](https://pubmed.ncbi.nlm.nih.gov/34746733)

1. Rubenstein, L. Z. (1 September 2006). "Falls in older people: epidemiology, risk factors and strategies for prevention". *Age and Ageing*. **35** (Supplement 2): ii37–ii41. [doi:10.1093/ageing/afl084](https://doi.org/10.1093/ageing/afl084). [PMID 16926202](https://pubmed.ncbi.nlm.nih.gov/16926202)

1. Bisdorff, A; Von Brevern, M; Lempert, T; Newman-Toker, DE (2009). "Classification of vestibular symptoms: towards an international classification of vestibular disorders". *Journal of Vestibular Research: Equilibrium & Orientation*. **19** (1–2): 1–13. [doi:10.3233/VES-2009-0343](https://doi.org/10.3233/VES-2009-0343). [PMID 19893191](https://pubmed.ncbi.nlm.nih.gov/19893191)

1. Zamponi, N.; Passamonti, C.; Cesaroni, E.; Trignani, R.; Rychlicki, F. (2011). "Effectiveness of vagal nerve stimulation (VNS) in patients with drop-attacks and different epileptic syndromes". *Seizure*. **20** (6): 468–474. [doi:10.1016/j.seizure.2011.02.011](https://doi.org/10.1016/j.seizure.2011.02.011). [PMID 21396833](https://pubmed.ncbi.nlm.nih.gov/21396833)

1. Abd-El-Barr, Muhammad M.; Joseph, Jacob R.; Schultz, Rebecca; Edmonds, Joseph L.; Wilfong, Angus A.; Yoshor, Daniel (2010). "Vagus nerve stimulation for drop attacks in a pediatric population". *Epilepsy & Behavior*. **19** (3): 394–399. [doi:10.1016/j.yebeh.2010.06.044](https://doi.org/10.1016/j.yebeh.2010.06.044). [PMID 20800554](https://pubmed.ncbi.nlm.nih.gov/20800554). [S2CID 13346234](https://api.semanticscholar.org/CorpusID:13346234)

1. Baraldi, Sara; Farrell, Fiona; Benson, Jennifer; Diehl, Beate; Wehner, Tim; Kovac, Stjepana (2015). ["Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit"](https://www.seizure-journal.com/article/S1059-1311%2815%2900195-8/fulltext). *Seizure*. **32**: 4–8. [doi:10.1016/j.seizure.2015.08.001](https://doi.org/10.1016/j.seizure.2015.08.001). [PMID 26552554](https://pubmed.ncbi.nlm.nih.gov/26552554)

1. Ruckenstein, MJ & Shea, JJ Jr (1999). [*Meniere's Disease*](https://books.google.com/books?id=M1tyxfMr4z4C&pg=PA266). Harris, JP (ed.). Kugler Publications. p. 266. ISBN 978-90-6299-162-4.

1. Hayback, PJ (2012-03-06). ["Mèniére's Disease"](http://vestibular.org/menieres-disease). *vestibular.org*. Vestibular Disorders Association. Retrieved 22 September 2015.

1. Hoeritzauer, Ingrid; Carson, Alan; Stone, Jon (2016-12-01). [""Cryptogenic Drop Attacks" Revisited"](https://jnnp.bmj.com/content/87/12/e1.180). *Journal of Neurology, Neurosurgery & Psychiatry*. **87** (12): e1. [doi:10.1136/jnnp-2016-315106.45](https://doi.org/10.1136/jnnp-2016-315106.45). [ISSN 0022-3050](https://www.worldcat.org/issn/0022-3050)

1. Parry, Steve W. & Kenny, Rose Anne (2005). ["Drop Attacks in Older Adults: Systematic Assessment Has a High Diagnostic Yield"](https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.2005.53013.x). *Journal of the American Geriatrics Society*. **53**: 74–78. [doi:10.1111/j.1532-5415.2005.53013.x](https://doi.org/10.1111/j.1532-5415.2005.53013.x). [PMID 15667379](https://pubmed.ncbi.nlm.nih.gov/15667379)

---
Adapted from the Wikipedia article [Drop attack](https://en.wikipedia.org/wiki/Drop_attack) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Drop_attack?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.