Drop Attacks and Vertigo Secondary to a Non-Meniere Otologic Cause

Abstract

Background: Tumarkin falls are sudden drop-attack falls that occur in a subset of patients with Meniere syndrome (endolymphatic hydrops), an inner ear disorder characterized by vertigo spells and hearing loss. 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. Setting: University referral center for disorders of balance and hearing. Methods: Case series (unselected) of all patients with Tumarkin falls and a normal audiogram at least 1 year after onset of vestibular symptoms (n = 6) from a retrospective analysis of the records of all patients with Tumarkin falls presenting to Neurotology Clinic at UCLA Medical Center, Los Angeles, Calif, from October 1, 1975, to February 1, 2001 (N=55). Quantitative audiologic and vestibular function testing, neurologic history, and examination were performed. Results: Five of 6 patients had unilateral caloric paresis, and 1 had bilateral vestibulopathy. Five of 6 had a personal and/or family history of migraine headaches meeting International Headache Society criteria. All patients had a subjective sensation of feeling pushed by an external force, and half of the patients had a subjective tilt of the environment concurrent with the fall. Conclusions: The incidence of migraine is high in this subgroup of patients with Tumarkin falls and normal hearing. The clinical description of the falls is similar to those associated with Meniere syndrome. Further studies are needed to understand the etiology of Tumarkin falls in these patients with normal hearing.

Drop attacks in elderly patients secondary to otologic causes with Meniere's syndrome or non-Meniere peripheral vestibulopathy

“…Furthermore, each patient characteristically fell in the same direction (i.e., patient 5 fell to the left, and patient 6 fell to the right), which was seldom occurred in vertebrobasilar insufficiency. Ishiyama et al [7] reported 6 patients with drop attacks typical of Tumarkin falls and normal hearing as in our last two patients. Presumably, the mechanism of the sudden falls in these patients is a peripheral vestibular phenomenon as in Ishiyama et al's cases.…”

“…Furthermore, we know of only one prior study of Tumarkin vestibulopathy with normal hearing [7]. Thus, we present 6 consecutive cases of elderly patients who had sudden falls typical of Tumarkin fall associated with (4) or without (2) hearing loss.…”

Migraine-related vertigo: Diagnosis and treatment

“…Another uncontrolled case series also found an increased prevalence of migraine among MD patients [35], although a questionnaire-based survey found a nonsignificant decrease in prevalence of migraine [36]. Migraine has also been associated with the falls attributed to the otolithic crises of Tumarkin, which are the sudden drop-attacks that have been noted in some patients with MD [37]. A partial explanation for the frequent concurrence of MD and migraine is that some patients may fit the diagnostic categories for both.…”

Auditory and Vestibular Assessment of Patients with Ménière’s Disease Who Suffer Tumarkin Attacks

“…These events are often described as 'otolithic catastrophes' [Tumarkin, 1936], 'Tumarkin otolithic attacks' or simply Tumarkin attacks (TA). DA are not exclusive to patients with MD as they also occur in patients with other peripheral vestibular disorders [Ishiyama et al, 2003;Brantberg et al, 2005;Lee et al, 2005].…”