Drop attacks

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By Douglas J Lanska MD MS MSPH

Drop attacks are also known as or subsume Otolithic catastrophe, Otolithic crisis of Tumarkin, and Tumarkin falls. –ed.

Dr. Douglas Lanska, Staff Neurologist at the VA Medical Center in Tomah, Wisconsin, explains the clinical presentation, pathophysiology, diagnostic work-up, and management of drop attacks.

Key Points

  • Drop attacks are sudden falls without loss of consciousness that are not precipitated by a specific stimulus, occur with abrupt onset and without warning, and are followed by a rapid return to baseline.
  • The term “drop attack” has subsequently been used to encompass a wide variety of sudden falls with or without existing conditions known to increase the risk of falls, with or without provocation by a specific stimulus, with or without loss of consciousness, and with or without significant baseline abnormalities.
  • A range of localizations for drop attacks is possible, but most commonly lower brainstem or spinal cord structures are implicated.
  • Drop attacks generally indicate transient impairment of bilateral central nervous system structures involved in maintenance of postural muscle tone and balance.
  • Tumarkin otolithic catastrophes (or crises) are drop attacks without associated autonomic or neurologic symptoms in patients with severe vestibular disease, usually due to Ménière disease.