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Gail Ishiyama, MD; Akira Ishiyama, MD; Robert W. Baloh, MD

Arch Neurol. 2003;60:71-75.

Background  Tumarkin falls are sudden drop-attack falls that occur in a subset of patients with Meniere syndrome (endolymphatic hydrops), an inner ear disorder characterized by vertigo spells and hearing loss.

Objective  To describe the clinical features and quantitative audiovestibular testing results in a case series of patients with Tumarkin falls, episodic vertigo, and normal hearing.

Setting  University referral center for disorders of balance and hearing.

Methods  Case series (unselected) of all patients with Tumarkin falls and a normal audiogram at least 1 year after onset of vestibular symptoms (n = 6) from a retrospective analysis of the records of all patients with Tumarkin falls presenting to Neurotology Clinic at UCLA Medical Center, Los Angeles, Calif, from October 1, 1975, to February 1, 2001 (N = 55). Quantitative audiologic and vestibular function testing, neurologic history, and examination were performed.

Results  Five of 6 patients had unilateral caloric paresis, and 1 had bilateral vestibulopathy. Five of 6 had a personal and/or family history of migraine headaches meeting International Headache Society criteria. All patients had a subjective sensation of feeling pushed by an external force, and half of the patients had a subjective tilt of the environment concurrent with the fall.

Conclusions  The incidence of migraine is high in this subgroup of patients with Tumarkin falls and normal hearing. The clinical description of the falls is similar to those associated with Meniere syndrome. Further studies are needed to understand the etiology of Tumarkin falls in these patients with normal hearing.

From the Department of Neurology (Drs G. Ishiyama and Baloh) and the Division of Head and Neck Surgery (Drs A. Ishiyama and Baloh), University of California, Los Angeles, UCLA School of Medicine.

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