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Clinical management
Published in Alistair Burns, Michael A Horan, John E Clague, Gillian McLean, Geriatric Medicine for Old-Age Psychiatrists, 2005
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean
The term 'drop attack' is often used, usually without a clear defmition. In fact, there is no generally agreed defmition. For our purposes, we refer to sudden falls which occur without warning, either with or without loss of consciousness. T he term is not a diagnosis, but a description of what happens. Studies of drop attacks are dif�cult to interpret owing to the lack of consis- tency in defming either the nature of the attack or the nature of the popu- lation from which the patient comes. Thus, in reading about drop attacks in different textbooks, the emphasis may be on CNS causes, vestibular causes, autonomic causes or vertebrobasilar insufficiency. Regardless, there always remain a large number of patients in whom no firm diagnosis of underlying disorder is possible: the older is the patient, the less likely is a firm diagnosis.
Meniere disease subtyping: the direction of diagnosis and treatment in the future
Published in Expert Review of Neurotherapeutics, 2022
Sulin Zhang, Zhaoqi Guo, E. Tian, Dan Liu, Jun Wang, Weijia Kong
It also has two special variants. Drop attacks (DA), initially described as ‘otolithic catastrophes’ by Tumarkin in 1936 [51], occurs without warning and without loss of consciousness but happens. It’s speculated that DAs tended to occur in the stage when the severity of EH worsened [52]. Lermoyez syndrome, namely cochlear symptoms such as hearing loss and tinnitus occurred initially, after, during or immediately prior to sudden attack of vertigo, improvement of the hearing on the affected ear is noted [53, 54]. It may be probably due to blockage in the ductus reunions caused by dislodged saccular otoconia and then the release of endolymph from the cochlea flooding into the semicircular canals. Lermoyez syndrome occurs most frequently in males and some elderly [53]. MD can occur in two special population: the elderly and children. Ten percent of patients with MD had a disease onset after 65 years [55]. And the elderly patients seem to have higher odds of drop attack [56]. Pediatric MD is rare, accounting for 1%–2.3% prevalence in Patients with MD [57, 58]. Bilateral affliction and symmetrical hearing levels on both ears and positive family history in pediatric MD are more prevalent than in adult MD [58].
Control of seizures in a clozapine-treated schizophrenia patient, using valproate: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2019
Hamza Ayaydın, Şermin Bilgen Ulgar
Drop attacks occurring with up-titration of clozapine dose was considered as atonic seizures clinically despite a lack of epileptic discharge on EEG in our patient; dramatic response to valproic acid/sodium valproate had a positive effect on therapeutic process and compliance. Atonic seizures manifest as spontaneous drop attacks. However, it may be difficult to recognize such attacks. The drop attacks may be misleadingly interpreted as myoclonic flexion of knee joint or psychogenic. Interestingly, it was reported that drop attack and mypclonus were seen due to clozapine use in a case report [30]. Moreover, drop attack could be misleadingly attributed to hypotension; thus, blood pressure measurement during drop attack is important to clarify drop attacks. However, it should be kept in mind that there may be atonic seizures in patients who have syncope attacks, drop attacks, or who suddenly drop objects from his/her hands during clozapine therapy and atonic seizures should be treated by using an anticonvulsant agent such as valproic acid/sodium valproate, which are considered as potential risk for tonic-clonic seizures [31].
Craniopharyngioma in a young woman with symptoms presenting as mechanical neck pain associated with cervicogenic headache: a case report
Published in Physiotherapy Theory and Practice, 2021
Firas Mourad, Fabio Cataldi, Alberto Patuzzo, Sara Tunnera, James Dunning, César Fernández-de-las-Peñas, Filippo Maselli
With rapidly changing headache symptoms and with the goal to reduce the likelihood of missing sinister pathological disorders underlying secondary headache symptoms a systematic approach including a detailed history taking to evaluate the headache was therefore performed (Cady, 2014). The patient reported common clinical craniopharyngioma features including lethargy, dizziness, blurred vision, mood changes (i.e., increased irritability), fatigue and nausea. Moreover, the patient reported a drop-attack episode just a few days prior to the initial visit.