ABSTRACT
In this chapter we outline the clinical approach to patients who fall because of an impairment or loss of consciousness. Following a set of definitions, we first describe the salient clinical features of disorders leading to such falls. Particular emphasis will be laid upon the distinction between falls caused by a true or an apparent loss of consciousness. Among falls caused by true loss of consciousness, we separate the clinical characteristics of syncopal falls (due to reflex syncope, orthostatic hypotension or cardiac syncope) from falls due to other causes of transient unconsciousness, such as seizures. With respect to the falls caused by an apparent loss of consciousness, we discuss the presentation of cataplexy, drop attacks, hyperekplexia and psychogenic falls. Each section contains practical recommendations for the treatment of these conditions. We underscore the clinical importance of a proper diagnosis, not only to minimize recurrent falls and injuries, but also to prevent further morbidity and mortality from the underlying disorder. We conclude by presenting some advice for the diagnostic work-up, in particular regarding history taking and the physical examination. We also touch upon several useful ancillary studies.
