Unexplained Falls: Causes and When to Seek Help

Unexplained falls?

About four or five years ago, one night while I was sleeping, my phone rang.
I wanted to get up to answer it, but for some reason, even though my feet should have had sensation, when I stepped onto the floor to walk, one of my feet suddenly felt completely weak, and I fell directly to the ground.
I am sure I did not compress my limbs while sleeping, and I did not experience any numbness in my hands or feet when I got up.
After waiting a moment, I quickly returned to normal and was able to stand up and continue walking.
Although this has happened infrequently, it has occurred several times over the past few years, always suddenly upon waking, such as when getting up in the middle of the night to use the bathroom or to answer the phone.

After a car accident last year, I had X-rays taken of my knee (AP/Lat) and lumbar spine (AP/Lat), and the doctors said there were no fractures.
They indicated that my soreness was likely due to a strain from the accident.
However, recently I have been feeling a dull pain in my right knee, especially noticeable when sitting cross-legged.
I would like to ask what diseases these two conditions might indicate, and which specialty I should consult in an outpatient setting?

Xiao Lan, 20~29 year old female. Ask Date: 2009/06/21

Dr. Lai Yanting reply Rehabilitation

1.
Based on your description, it may be helpful to recall if you took any sleeping pills or sedatives in the days leading up to the fall.
This could potentially explain why you might have been in a deep sleep and suddenly got up during the night, leading to insufficient reaction time.
Alternatively, it could be due to orthostatic hypotension, which typically causes dizziness upon standing.
Since you quickly returned to normal after the fall, it is unlikely to be caused by a specific illness.
It is advisable to consult a neurologist for a second opinion.
2.
If you experience knee pain while sitting cross-legged, pain on the outer side may suggest a lateral collateral ligament strain, while pain on the inner side could indicate a meniscus tear or bursitis.
If the entire knee is achy, it may be indicative of knee arthritis, among other conditions.
It is recommended to seek further evaluation from a rehabilitation specialist or an orthopedic surgeon.
Thank you for your inquiry!

Reply Date: 2009/06/21

More Info

Understanding unexplained falls, especially those that occur upon waking or during the night, can be quite complex. The experiences you've described—sudden weakness in one leg leading to falls—could be attributed to several potential causes, ranging from neurological issues to musculoskeletal problems.

Possible Causes of Unexplained Falls
1. Orthostatic Hypotension: This condition occurs when a person stands up from a sitting or lying position and experiences a drop in blood pressure, leading to dizziness or fainting. If you are waking up and suddenly trying to stand, your body may not be adjusting quickly enough to the change in position, causing you to feel weak or faint.

2. Sleep Disorders: Conditions such as sleep apnea can lead to sudden awakenings and may cause confusion or disorientation upon waking. This could contribute to falls if you are not fully alert when you try to get up.

3. Neurological Issues: Conditions affecting the nervous system, such as transient ischemic attacks (TIAs) or even more chronic conditions like multiple sclerosis, can lead to sudden weakness or loss of coordination. If these episodes are accompanied by other symptoms, such as numbness or visual disturbances, it would be wise to consult a neurologist.

4. Musculoskeletal Problems: Given your history of a car accident and ongoing knee pain, there could be underlying musculoskeletal issues contributing to your falls. Weakness or pain in the knee or leg could affect your balance and stability, making you more prone to falls.

5. Medication Side Effects: If you are taking any medications, especially those that affect blood pressure or the central nervous system, they could be contributing to your symptoms. It's important to review any medications with your healthcare provider.

When to Seek Help
You should seek medical attention if:
- The falls become more frequent or severe.

- You experience additional symptoms such as confusion, severe headaches, or visual disturbances.

- You have a history of cardiovascular issues or other chronic health conditions.

- You notice any changes in your ability to walk or maintain balance.

Recommended Specialists
Given the symptoms you've described, it would be advisable to start with a primary care physician who can perform an initial evaluation. They may then refer you to specialists such as:
- Neurologist: To rule out any neurological conditions that could be causing your symptoms.

- Orthopedic Specialist: If your knee pain persists, an orthopedic evaluation may be necessary to assess for any injuries or conditions affecting your knee joint.

- Cardiologist: If there are concerns about blood pressure or heart-related issues contributing to your falls.

Conclusion
Unexplained falls can be a sign of underlying health issues that require attention. It’s essential to keep a detailed record of when these falls occur, any accompanying symptoms, and any potential triggers. This information will be invaluable to your healthcare provider in diagnosing and managing your condition effectively. Additionally, addressing your knee pain with appropriate treatment may also help improve your overall stability and reduce the risk of falls. Always prioritize your safety and seek medical advice when experiencing concerning symptoms.

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