This study was conducted to determine the prevalence and risk factors associated with downer cow syndrome (DCS) in Middle Egypt. Design: Case-control study Animals: A total of 1,300 cross breeding Holestein dairy cattle in 30 small scale farms were involved in the study during the period from September 2018 to August 2019. Procedures: Three hundred and twenty downers (24.6 %) were investigated and were subject to clinical examination. A questioner to farm owners was designed focusing on risk factors for occurrence of downers.