Vitamin B12 Deficiency Related Syncope in a Young Military Pilot

Area of Science:

• Aeromedical safety
• Neurology
• Hematology

Background:

• Syncope and near-syncope are common symptoms, often benign but concerning if related to autonomic dysfunction.
• Autonomic dysfunction can cause orthostatic intolerance, posing risks during flight.
• Vitamin B12 deficiency is a treatable condition with diverse neurological manifestations, including autonomic dysfunction.

Observation:

• A pilot presented with atypical syncope and abnormal tilt-table testing.
• Progressively abnormal hematologic findings and intrinsic factor antibodies were noted.
• The patient experienced syncope attributed to vitamin B12 deficiency.

Findings:

• Vitamin B12 replacement therapy normalized cardiovascular responses to stress tests.
• Post-treatment, the pilot's centrifuge assessment was unremarkable.
• Neurological abnormalities associated with vitamin B12 deficiency were reversible.

Implications:

• Recognizing subtle and serial laboratory findings is crucial for diagnosing reversible causes of syncope.
• Early identification and treatment of vitamin B12 deficiency can mitigate aeromedical risks.
• This case underscores the importance of a comprehensive approach to evaluating pilots with unexplained syncope.