True drop attacks are characterized by a sudden fall without loss of consciousness. Cardiac disease and epilepsy are widely accepted causes, but other etiologies have been described, including vestibulopathy, hypothyroidism, third ventricle or posterior fossa cysts, cervical spine disease, and brainstem ischemia.1-3 We present a case of drop attacks caused by an anomalous circle of Willis in the setting of a critical stenosis of the ipsilateral internal carotid artery (ICA). A 73-year-old right-handed man with a history of hypertension and past smoking, on oral anticoagulation for atrial fibrillation, presented to an outside institution with several months of drop attacks. The episodes occurred one to four times per week and he described his legs giving out, seeing the floor “coming up,” and then being on the ground. There were no prodromal symptoms such as lightheadedness, palpitations, or residual weakness after an attack. Witnesses confirmed no alteration …