REFERENCE · DIAGNOSTIC TECHNIQUE

Reconstructing a Sudden Fall

Clinician-focused educational reference. Use within professional competence and an agreed assessment plan.

Purpose and Suitability
Anatomy and Physiology
Preparation and Safety
Performing the Assessment
Interpreting Findings
Explaining the Result
Evidence and Limitations
Media and Accessibility
Research and Sources

Purpose and Suitability

Use a structured history when a person reports a sudden fall. First establish whether the event is a fall without definite blackout, a loss-of-consciousness event, sustained weakness, or a longer seizure-like episode. The description guides assessment; it does not itself establish a functional cause. 1

Phenotype: The observable pattern of symptoms and their course.

This page owns event reconstruction and witness information. See differential assessment for alternative causes.

Anatomy and Physiology

Remaining upright involves movement, balance, sensation and circulation. A history cannot locate a single failed brain pathway. Proposed relationships with dissociation describe a possible clinical formulation, not a mechanism demonstrated in every person. A gap in memory around impact does not by itself prove a blackout or a functional event. 1

Preparation and Safety

Check immediate injury and medical needs before taking a detailed history. Ask whether discussing events brings on symptoms; offer breaks, written answers and a supporter if wanted. Take the account seated or otherwise safely supported. Do not remove mobility aids, surprise the person or request a demonstration of falling.

Performing the Assessment

Preserved clinical outline

Define the event from standing or walking through impact and recovery, including warning, recall, awareness, motor pattern, autonomic features, injury and duration.
Obtain witness description or consensual video when available, recognizing selection and interpretation limits.
Examine gait, strength, movement, cardiovascular and vestibular features as guided by the history.
Consider syncope and orthostatic causes, epilepsy including atonic events, cataplexy or narcolepsy, vestibular or Tumarkin attacks, medication effects, mechanical falls and other neurological, cardiac or musculoskeletal causes.
Identify whether the event is better formulated as functional gait/weakness, a functional seizure or a functional drop attack. Record overlap rather than forcing one label when two established phenotypes coexist.
Explain the basis and limits of the formulation and provide an injury-response plan while diagnostic work continues where needed.

Authored event record

This documentation aid is not a validated diagnostic score.

Period	Record	Keep uncertainty visible
Before	Posture, activity, warning, medication timing and surroundings	No warning recalled is not proof that none occurred
During	Fall direction, buckling or stiffening, responsiveness, colour and breathing	Separate direct observation from interpretation
After	Injury, time to interaction, confusion, weakness and assistance	Rapid recovery does not identify the cause
Across events	Similarities, differences, frequency and existing diagnoses	Record distinct event types separately

Ask the person first, then add a witness account with consent. Review only an existing or safely obtained recording; missing footage is not a barrier to care.

Interpreting Findings

A coherent event pattern can support a specialist formulation alongside examination and targeted investigations. An associated functional sign supports the symptom it tests; it does not prove why the person fell. If awareness is uncertain, document that uncertainty and assess the loss-of-consciousness possibilities. Do not convert a normal scan or ordinary clinic walk into a positive drop-attack sign.

Explaining the Result

Authored explanation example: “The sequence you and your witness described helps us decide which causes to assess. Some parts fit the working explanation, while these questions remain open. We can plan support for the falls while we investigate.”

Record the reasons supporting the diagnosis, alternatives considered and follow-up, rather than simply writing “unexplained fall”.

Evidence and Limitations

Hoeritzauer and colleagues retrospectively reviewed 83 patients seen by one clinician. Overlap with other functional symptoms supports further assessment, not a diagnostic-accuracy estimate. The study did not validate this authored record or a universal bedside test. Its abstract was checked for this expansion; full-text appraisal remains pending. 1

Media and Accessibility

Preferred format: A narrated flow diagram beginning with “sudden fall” and separating definite blackout, prolonged seizure-like features, gait or weakness-related buckling, and the no-definite-blackout/rapid-recovery presentation. Keep differential branches non-exhaustive and direct viewers to assessment.

Clinical example: Use a fictional consultation or actor. Show the questions asked before, during and after an event, what a witness can report, and why no single normal test proves the diagnosis.

Do not stage a fall, withdraw an aid, provoke an event or use injury footage. Captions should distinguish “drop attack” as an event description from “functional drop attack” as a clinical formulation.

Research and Sources

Citation	Full citation and evidence limit
[1]	Hoeritzauer I, Carson AJ, Stone J. “Cryptogenic drop attacks” revisited: evidence of overlap with functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry. 2018;89(7):769–776. FND-CIT-0059. https://doi.org/10.1136/jnnp-2017-317396

Continue: Differential Assessment of Drop Attacks

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