'Cardiogenic vertigo'--true vertigo as the presenting manifestation of primary cardiac disease.
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.


METHODS
Bedside history and examination, non-contrast head CT scan, electrocardiogram, transthoracic echocardiogram, and bedside cardiac telemetry.


METHODS
Sick sinus syndrome or severe reflex bradycardia with asystole causing recurrent, episodic vertigo, presyncope, non-vertiginous dizziness and syncope (Stokes-Adams attacks).


RESULTS
Placement of a temporary pacing wire, followed by surgical implantation of a single-chamber ventricular (VVI) pacemaker.
Newman-Toker
David E
DE
Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA. toker@jhu.edu
Camargo
Carlos A
CA
D000219:Adams-Stokes Syndrome / Q000150:complications / Q000503:physiopathology; D000369:Aged, 80 and over; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006334:Heart Function Tests; D006801:Humans; D010138:Pacemaker, Artificial; D012804:Sick Sinus Syndrome / Q000150:complications / Q000175:diagnosis; D013686:Telemetry; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000209:etiology; D014717:Vertigo / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy