Cryptogenic Drop Attacks — SCE Neurology MCQ

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ModerateMovement DisordersCryptogenic Drop AttacksSCE Neurology

A 55-year-old man presents with recurrent episodes of unprovoked falls without loss of consciousness. He has no warning before falling. He describes his legs suddenly giving way and he drops to the ground, remaining fully conscious throughout. There is no associated weakness or limb jerking. Episodes last <2 seconds. Between episodes he is neurologically normal. MRI brain shows no structural lesion. What is the most likely diagnosis?

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Correct answer: D — Cryptogenic drop attacks

Cryptogenic drop attacks are episodes of sudden falling without loss of consciousness, occurring predominantly in middle-aged women (though can occur in men). The patient suddenly drops to the ground — usually forwards — and is immediately alert. There is no warning, no limb jerking, no weakness before the fall, and no post-event confusion. The mechanism is unknown. EEG is normal. They are a diagnosis of exclusion after cardiac, neurological, and vestibular causes have been excluded. A: Atonic seizures cause loss of consciousness/awareness and have EEG changes. B: Cataplexy is triggered by emotion and associated with narcolepsy. D: VB TIA would have other posterior circulation features. E: Orthostatic hypotension causes pre-syncope/syncope.

Reference: Stevens & Lowe Drop Attacks Review; ABN Falls Guidelines