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Neurally mediated syncope presenting with paroxysmal positional vertigo and tinnitus
Fumiyuki Goto1, Tomoko Tsutsumi, Iwao Nakamura
1Department of Otorhinolaryngology, Hino Municipal Hospital, 4-3-1 Tamadaira Hino-shi, Tokyo, Japan. amifumi@bc5.so-net.ne.jp
Auris, Nasus, Larynx
|November 9, 2011
Summary
A patient
Area of Science:
- Neurology
- Cardiology
Background:
- Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo.
- Misdiagnosis can occur if symptoms are atypical or patient history is not thoroughly investigated.
Observation:
- A 72-year-old man presented with positional vertigo and tinnitus, initially suspected as BPPV.
- The patient's symptoms, including positional vertigo with pyrosis, were actually presyncope, and he feared diagnostic maneuvers.
- Provocation tests for BPPV were negative, and conventional treatments were ineffective.
Findings:
- Cardiovascular investigation revealed paroxysmal bradycardia, leading to a diagnosis of neurally mediated syncope.
- Implantation of a pacemaker resolved the patient's dizziness and presyncope symptoms.
- This case highlights the importance of detailed patient history and ruling out cardiac causes.
Implications:
- Thorough clinical history is crucial for accurate diagnosis, especially when patients struggle to articulate symptoms.
- Cardiovascular disorders, particularly neurally mediated syncope, should be considered in patients with suspected BPPV who lack characteristic nystagmus.
- Prompt cardiac evaluation can prevent misdiagnosis and ensure appropriate treatment for potentially serious conditions.
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