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Drop Attacks


Presentation

  • Its clinical presentation varies greatly from asymptomatic incidental mass to serious life-threatening cardiovascular complications.[ncbi.nlm.nih.gov]
  • A case of drop attack associated with vertical vertigo is presented. Vestibular tests were performed in order to assess the involvement of inner ear. Caloric test and ice water test reveal no response.[ncbi.nlm.nih.gov]
  • We report the case of a 28-year-old man who presented in emergency for recurrent drop-attacks. Ultrasound imaging and angio computed tomography revealed a left cervical tumor, and the patient underwent surgery.[ncbi.nlm.nih.gov]
  • The clinical features and treatment of seven patients with drop attacks attributable to inner ear disease presenting after age 65 are described. A neurologic or cardiovascular cause of drop attacks was initially suspected.[ncbi.nlm.nih.gov]
  • We herein describe a childhood case of BHC that presented with l-thyroxine-responsive drop attacks. A genetic analysis revealed an interstitial deletion that included two enhancer regions of NKX2-1, providing genetic confirmation of BHC.[ncbi.nlm.nih.gov]
Myxedema
  • The diagnostic work-up revealed severe myxedema. Treatment with eltroxin resulted in complete clinical and endocrine recovery and disappearance of DA while with discontinuation of hormone replacement therapy, DA reappeared.[ncbi.nlm.nih.gov]
Asymptomatic
  • Its clinical presentation varies greatly from asymptomatic incidental mass to serious life-threatening cardiovascular complications.[ncbi.nlm.nih.gov]
Normal Hearing
  • Further studies are needed to understand the etiology of Tumarkin falls in these patients with normal hearing.[ncbi.nlm.nih.gov]
Severe Mental Retardation
  • Severe mental retardation is considered to be predictive of unfavorable seizure outcome after callosotomy. Very little attention has been paid on the influence of callosotomy on the psychosocial burden on the patients' families.[ncbi.nlm.nih.gov]
  • Coffin-Lowry syndrome is a well-defined clinical entity classically associated with moderate to severe mental retardation, characteristic facial features, skeletal deformities, and tapering fingers.[ncbi.nlm.nih.gov]
  • As presurgical factors, we analyzed the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, EEG abnormality, MRI abnormality, and extent of callosal section (total or partial callosotomy).[ncbi.nlm.nih.gov]
  • As presurgical factors, the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, electroencephalograph abnormalities, magnetic resonance imaging abnormalities, and (18)fluorodeoxyglucose positron[ncbi.nlm.nih.gov]
Aggressive Behavior
  • Falls, episodes of aggressive behavior, and IQ were quantified. Autonomy in activities of daily living, axial tonus, and speech generated a functional score ranging from 0 to 13.[ncbi.nlm.nih.gov]
Chorea
  • Benign hereditary chorea (BHC) is a rare autosomal dominant disease that is characterized by non-progressive chorea with early-childhood-onset, congenital hypothyroidism, and neonatal respiratory distress.[ncbi.nlm.nih.gov]
  • A heterozygous mutation of the TITF1/NKX2-1 gene (14q13) was detected in both patients, allowing the diagnosis of benign hereditary chorea (BHC). Treatment with levodopa attenuated abnormal movements and led to disappearance of drop attacks.[ncbi.nlm.nih.gov]
  • Extremely unusual situations include chorea (Rosati et al, 2015), rare genetic disorders (e.g. Toelle et al, 2014; Havaligi et al, 2007).[dizziness-and-balance.com]
Episodic Vertigo
  • OBJECTIVE: To describe the clinical features and quantitative audiovestibular testing results in a case series of patients with Tumarkin falls, episodic vertigo, and normal hearing.[ncbi.nlm.nih.gov]
  • Introduction Meniere’s disease (MD) is a distressing disorder characterized by fluctuating hearing loss, tinnitus, episodic vertigo and aural fullness.[ncbi.nlm.nih.gov]
Mental Deterioration
  • RESULTS: Seventy four per cent of patients had a poor prognosis and 45% were mentally retarded; 52% of patients with epileptic drop attacks continued to have epileptic falls associated with partial seizures and mental deterioration at the end of the follow[ncbi.nlm.nih.gov]
  • In our opinion therefore, the mental deterioration depends on the poor outcome, the frequent drops, and the process of secondary epileptogenesis.[jnnp.bmj.com]
Personality Change
  • Drop attacks are ominous because they occur so frequently, resist therapy, are physically dangerous, and portend personality change.[ncbi.nlm.nih.gov]
  • Drop attacks are ominous because they occur so frequently, resist therapy, are physically dangerous, and portend personality change. 1985 by Modern Medicine Publications, Inc.[neurology.org]
Nystagmus
  • Neither had sound- or pressure-induced nystagmus. Repair of the dehiscence in one case stopped the drop attacks, supporting a causal relationship between the dehiscence and the drop attacks.[ncbi.nlm.nih.gov]
  • Due to the presence of a torsional nystagmus, observed during an attack, it is tempting to speculate vertical canal involvement.[ncbi.nlm.nih.gov]

Workup

  • The favorable long-term outcome in drop attack patients with unrevealing medical and neurologic workups suggests that treatment is unwarranted for an isolated drop attack.[ncbi.nlm.nih.gov]
  • METHODS: We selected patients with Chiari drop attacks who had negative workups for cardiac syncope, followed by tilt table testing and subsequent surgical decompression. We report test results and clinical outcomes following CM1 decompression.[ncbi.nlm.nih.gov]
  • Workup included magnetic resonance imaging of the brain and internal auditory canals with gadolinium, and auditory brainstem evoked potentials, the results of which were normal. Serial audiograms were normal.[jamanetwork.com]
Generalized Epileptiform Discharges
  • Absence of generalized epileptiform discharges on the 1-year postoperative EEG was significantly associated with a favorable seizure outcome.[ncbi.nlm.nih.gov]
Positron Emission Tomography Abnormal

Treatment

  • CONCLUSION: Intratympanic gentamicin treatment appears to be a long-lasting and effective treatment for MD with DAs. 2014 The American Laryngological, Rhinological and Otological Society, Inc.[ncbi.nlm.nih.gov]
  • Treatment of drop attacks is still a matter of discussion; most cases have a benign course with spontaneous remission and no treatment is necessary. In severe cases, aggressive treatment (surgical or pharmacological) is necessary.[ncbi.nlm.nih.gov]
  • Fifty-four percent of the patients received no treatment, but similar percentages of treated (82%) and untreated (84%) patients were symptom-free at follow-up.[ncbi.nlm.nih.gov]
  • The intratympanic dexamethasone (ITD) is one of primary treatments for MD or DEH.[ncbi.nlm.nih.gov]
  • The clinical features and treatment of seven patients with drop attacks attributable to inner ear disease presenting after age 65 are described. A neurologic or cardiovascular cause of drop attacks was initially suspected.[ncbi.nlm.nih.gov]

Prognosis

  • They are important to recognize because their prognosis is relatively benign compared to other causes of drop attacks.[ncbi.nlm.nih.gov]
  • RESULTS: Seventy four per cent of patients had a poor prognosis and 45% were mentally retarded; 52% of patients with epileptic drop attacks continued to have epileptic falls associated with partial seizures and mental deterioration at the end of the follow[ncbi.nlm.nih.gov]
  • Seventy four per cent of our patients had a poor prognosis and 45% were mentally retarded. Mental retardation significantly differs for patients with epileptic drop attacks and the control group.[jnnp.bmj.com]
  • Because ESES usually is accompanied by a good long-term seizure prognosis, the objective of this study was to examine ESES outcome among patients with a structural lesion that is usually highly epileptogenic and has a low seizure remission trend.[n.neurology.org]
  • Prognosis It is difficult to predict how Ménière’s disease will affect a person’s future. Symptoms can disappear one day and never return. Or they might become so severe that they are disabling.[vestibular.org]

Etiology

  • However, the specificity and etiology of drop attacks have come under some scrutiny in recent years. The patient described in this case report experienced frequent drop attacks that were effectively prevented with nifedipine.[ncbi.nlm.nih.gov]
  • A variety of etiologies are known to be responsible for symptomatic DA, but the reason for idiopathic DA remains obscure. A 70-year-old woman who suffered from classic DA over a period of a year is described.[ncbi.nlm.nih.gov]
  • Abstract An inner ear etiology for drop attacks is easily overlooked and seldom mentioned in the literature. Cardiovascular pathology is what generally is looked for, e.g. transitory ischemic attacks.[ncbi.nlm.nih.gov]
  • After clinical investigations, including prolonged video/EEG telemetry, tilt-table testing, and multiple sleep latency tests, the etiology of her drop attacks remained elusive.[ncbi.nlm.nih.gov]
  • Both have various etiologies (traumatic, vascular of tumoural). Both manifestations have an individual character. In this respect I would like to make 5 clinical observations (3 CF and 2 DA).[ncbi.nlm.nih.gov]

Epidemiology

  • "Falls in older people: epidemiology, risk factors and strategies for prevention". Age and Ageing . 35 (Supplement 2): ii37–ii41. doi : 10.1093/ageing/afl084 . PMID 16926202 . Bisdorff, A; Von Brevern, M; Lempert, T; Newman-Toker, DE (2009).[en.wikipedia.org]
  • His research activity has focussed on epidemiology and pathophysiology of dystonia, Tourette’s syndrome (with a special focus on the role of environmental factors and immunity), functional movement disorders and drug-induced movement disorders.[books.google.ro]
  • Epidemiology of gout in women. Arthritis and Rheumatism, 62(4): 1069-1076. Burns CM, Wortmann RI (2013). Clinical features and treatment of gout. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1554-1575.[northshore.org]
Sex distribution
Age distribution

Pathophysiology

  • Possible pathophysiologic mechanisms are discussed and the relevant literature is reviewed.[ncbi.nlm.nih.gov]
  • Cerebellar Fits (CF) and Drop Attacks (DA) are rare pathophysiological disorders of the Brain Stem (BS) and of the Cerebellar System (CS). Both have various etiologies (traumatic, vascular of tumoural).[ncbi.nlm.nih.gov]
  • In addition, there is a significantly higher incidence of otolithic membrane injury in patients with MD and delayed EH compared with patients without hydrops, suggesting that the underlying pathophysiology in VDA results from injury to the otolithic membrane[ncbi.nlm.nih.gov]
  • The author explains the clinical presentation, pathophysiology, diagnostic work-up, and management of drop attacks.[medlink.com]
  • Similarly rare, yet pathophysiologically more reasonable, is the case of a high grade carotid artery stenosis with contralateral hypoplastic A1-segment – when the compromised ICA supplies both anterior cerebral arteries.[jneuro.wordpress.com]

Prevention

  • The patient described in this case report experienced frequent drop attacks that were effectively prevented with nifedipine. Possible pathophysiologic mechanisms are discussed and the relevant literature is reviewed.[ncbi.nlm.nih.gov]
  • During this surgical procedure the vestibular (balance) part of the nerve is selectively cut to prevent further drop attacks. The auditory (hearing) part and thus the hearing is preserved in this way.[lmhofmeyr.co.za]
  • Greenwood and Hopkins 3 later commented that some, although remaining conscious, appeared unable to generate sufficient antigravity muscle tension in time to prevent falling.[jnnp.bmj.com]
  • 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 [ edit ] Rubenstein, L. Z. (1 September 2006).[en.wikipedia.org]
  • He wears a safety jacket to prevent him hitting the floor. (2) A tonic contraction of the facial, axial, and upper limbs muscles appears. The patient bends his head and trunk slightly forwards. (3–5) One second later he begins to drop.[jnnp.bmj.com]

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