Recurrent syncopal events preceded by transient abnormal gait disturbance.

Area of Science:

• Neurology
• Cardiology
• Geriatrics

Background:

• Recurrent transient loss of consciousness (syncope) with preceding gait abnormalities is a complex clinical presentation.
• Standard investigations including ECG, echocardiogram, and neuroimaging were inconclusive in a patient with these symptoms.

Purpose of the Study:

• To investigate the underlying cause of recurrent syncope and transient gait disturbances in an elderly patient.
• To explore the role of orthostatic hypotension (OH) and alcohol consumption in this presentation.

Main Methods:

• A comprehensive workup was performed, including cardiovascular and neurological assessments.
• A positive tilt table test was crucial in diagnosing severe orthostatic hypotension.

Main Results:

• The patient experienced recurrent syncope associated with transient abnormal posture and gait, including leg stiffening, shuffling gait, and ataxia.
• Severe orthostatic hypotension (OH) was confirmed via a positive tilt table test, explaining the syncopal episodes.
• Acute alcohol consumption was identified as a significant exacerbating factor for OH and subsequent cerebral hypoperfusion.

Conclusions:

• Severe orthostatic hypotension, particularly when exacerbated by alcohol, can manifest as recurrent syncope with transient gait disturbances.
• This case underscores the importance of considering OH in patients with unexplained syncope and gait abnormalities.
• Further documentation and research are essential for refining diagnostic and management strategies for such complex cases.