Abstract

Background
: Dropt attack is defined as a sudden fall with or without loss of consciousness. Vertebrobasilar insufficiency and epilepsy were known common causes in neurological conditions. However, many neurologists are unaware of the association with inner ear disease, especially in patients who presenting drop attack after age 65. Objectives : To describe the clinical features of 5 patients with drop attack associated with Meniere's disease (4) or delayed endolymphatic hydrops (1).
Methods
: Five patients with drop attacks presumed association with Meniere's disease or delayed endolymphatic hydrops were evaluated. Each patient filled out a standard dizziness questionnaire including history of sudden falling. Audiovestibular function testing including pure tone audiometry, speech audiometry, auditory brainstem response, electronysatgmography, and rotational chair test were performed in all patients. Brain MRI, electroencephalography (EEG), and cardiovascular evaluation such as electrocardiography and echocardiogram were also performed to exclude the known other causes for drop attack.
Results
: Each patient described a drop attack as a sensation of being pushed (2), thrown (1) to the ground or a sudden illusion of movement of the environment (2). All patients demonstrated unilateral (4) or bilateral (1) sensorineural hearing loss of moderate to profound degree. All tests for exclusion of possible other causes were negative. In all cases, the patients had a history of episodic vertigo before onset of falls. Most of drop attacks were not associated with episodic vertigo. Only 2 cases reported the classic Meniere's triad of fluctuating hearing loss, tinntius, and aural fullness during episodes of vertigo. Two patients showed a unilateral caloric weakness to caloric stimulation.
Conclusion
: Our results suggest that otologic cause should be considered in the differential diagnosis of the drop attack even if the otologic symptoms and signs were not classical for Meniere's syndrome. Neurologist should be carefully asked the history of the hearing loss in patients presenting with sudden falls.