Elderly woman with exaggerated startle reflex and unconscious drop attack

Exaggerated startle reflex is an abnormal phenomenon originating from the caudal brainstem in which unheralded sensory stimuli evoke massive, generalized motor responses. Some patients with exaggerated startle reflex are reported to fall during startle. We report a sporadic case of exaggerated startle reflex with unconscious drop attack elicited by unexpected auditory stimuli as late-onset involuntary movements. It is clinically important as one of the underlying diseases presenting unconscious drop attack, especially for older adults.