Cerebrovascular dysautoregulation syndrome complex--brain hypoperfusion precedes hypotension and cardiac asystole

A 43-year-old male with history of recurrent episodes of syncope, non-sustained wide complex tachycardia and structurally normal heart was studied. Syncope was induced with upright tilt provocation, while monitoring cerebral blood flow velocity with Doppler ultrasound, concurrently with invasive blood pressure, heart rate and rhythm determination. Postural induced cerebral hypoperfusion preceded hypotension and cardiac asystole. Treatment with ephedrine and transdermal scopolamine was effective in preventing symptoms.