Cardiovascular syncope is the most common cause of drop attacks in the elderly.

Drop attacks are defined as a sudden loss of postural tone without loss of consciousness. The mechanism is often unknown. This report examines findings in consecutive elderly patients with drop attacks referred to a dedicated "syncope and falls" center. Thirty-five patients were included. A diagnosis was established in 25 (71%); cardioinhibitory cartoid sinus syndrome (CSS) or mixed CSS in 15, vasodepressor CSS in 3, orthostatic hypotension in 5, vasovagal syncope in 1, and gait imbalance in 1. In 21%, more than one pathological diagnosis was present. In conclusion, absence of a history of syncope is unreliable in elderly patients, and these individuals should be routinely investigated for hemodynamic changes during carotid massage and standing.