Abstract
Background A 90-year-old woman presented to a hospital emergency department with a brief loss of consciousness that was heralded by spinning vertigo lasting approximately 2 min. She had a long history of intermittent brief episodes of rotatory vertigo, presyncope, and non-vertiginous dizziness, occurring either with or without loss of consciousness. Although initially attributed to symptomatic carotid artery stenosis, these episodes persisted, despite surgical restoration of carotid artery blood flow 1 year after her first syncope. Her medical history was otherwise notable for hypertension, mild depression and a gradual decline in gait and balance function attributed to left hip arthritis and older age.
Investigations Bedside history and examination, non-contrast head CT scan, electrocardiogram, transthoracic echocardiogram, and bedside cardiac telemetry.
Diagnosis Sick sinus syndrome or severe reflex bradycardia with asystole causing recurrent, episodic vertigo, presyncope, non-vertiginous dizziness and syncope (Stokes–Adams attacks).
Management Placement of a temporary pacing wire, followed by surgical implantation of a single-chamber ventricular (VVI) pacemaker.
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References
Cappello M et al. (1995) Dizziness and vertigo in a department of emergency medicine. Eur J Emerg Med 2: 201–211
Kroenke K and Jackson JL (1998) Outcome in general medical patients presenting with common symptoms: a prospective study with a 2-week and a 3-month follow-up. Fam Pract 15: 398–403
Herr RD et al. (1989) A directed approach to the dizzy patient. Ann Emerg Med 18: 664–672
Drachman DA and Hart CW (1972) An approach to the dizzy patient. Neurology 22: 323–334
Drachman DA (1998) A 69-year-old man with chronic dizziness. JAMA 280: 2111–2118
Delaney KA (2003) Bedside diagnosis of vertigo: value of the history and neurological examination. Acad Emerg Med 10: 1388–1395
Eviatar A (1970) Severe bradycardia induced by caloric test in cardiac patients. Ann Otol Rhinol Laryngol 79: 680–684
Culic V et al. (2001) Correlation between symptomatology and site of acute myocardial infarction. Int J Cardiol 77: 163–168
Low PA et al. (1995) Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc 70: 617–622
Ruff RL et al. (1981) Transient ischemic attacks associated with hypotension in hypertensive patients with carotid artery stenosis. Stroke 12: 353–355
Moossy J (1966) Morphology, sites and epidemiology of cerebral atherosclerosis. Res Publ Assoc Res Nerv Ment Dis 41: 1–22
Muller-Kuppers M et al. (1997) Intracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Eur Neurol 37: 146–156
Wityk RJ et al. (1998) Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 55: 470–478
Matula C et al. (1997) The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol 48: 125–131
Bartels E et al. (1992) Duplex ultrasonography of vertebral arteries: examination, technique, normal values, and clinical applications. Angiology 43: 169–180
Acknowledgements
We thank Dr Julie Newman-Toker and Dr David Zee for critically reviewing the manuscript and providing us with valuable editorial advice. The preparation of this manuscript was supported by grants from the Foundation for Education and Research in Neurologic Emergencies (FERNE), and the National Institutes of Health (NIH) (National Center for Research Resources K23 RR17324-01, “Building a New Model for Diagnosis of ED Dizzy Patients”).
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Newman-Toker, D., Camargo, C. 'Cardiogenic vertigo'—true vertigo as the presenting manifestation of primary cardiac disease. Nat Rev Neurol 2, 167–172 (2006). https://doi.org/10.1038/ncpneuro0125
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DOI: https://doi.org/10.1038/ncpneuro0125
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