Postural Orthostatic Tachycardia Syndrome Presenting With Recurrent Syncope After Cervical Spinal Cord Injury

Syncope is a manifestation of autonomic dysfunction after high spinal cord injury. However, it is rarely reported as a feature of postural orthostatic tachycardia syndrome (POTS) after spinal cord injury. This case report describes a male in his 50s suffering from C2 spinal cord injury who developed recurrent postural syncope post-injury. These events were characterized by orthostatic tachycardia upon standing and could even be induced by seated head-tilt maneuvers, fulfilling the diagnostic criteria for POTS. These patients have substantial risks of fall-related morbidity. Heart rate variability and sympathetic skin response assessments help elucidate the underlying autonomic pathophysiological mechanisms. Syncope may be the predominant symptom during transfers, standing, or seated head-tilt positioning. Notably, documenting heart rate fluctuations during transient syncopal events is challenging. Infections constitute established triggers for syncope. Comprehensive management strategies may achieve complete resolution of syncopal episodes.