title: Neurally mediated syncope presenting with paroxysmal positional vertigo and tinnitus.
abstract: A 72-year-old man with positional vertigo and tinnitus was referred to us. He did not want to perform provoking test except once due to his fear. No positional nystagmus was provoked. He found that his attacks usually occurred when he lay on his right ear. From his clinical history, benign paroxysmal positional vertigo was suspected. Conventional pharmacotherapy as well as non-specific physical therapy did not have significant effect. His feeling of positional vertigo with pyrosis was actually presyncope. We suspected cardiovascular disorders, and referred him to a cardiologist. Portable cardiogram monitoring revealed paroxysmal bradycardia. He was diagnosed with neurally mediated syncope, and a pacemaker was implanted. His paroxysmal dizziness soon disappeared. It is important to study the clinical history of the patients in detail, as they are not always able to accurately explain their symptoms. We should carefully rule out cardiovascular disorders, especially when we see the patients with suspected BPPV without the characteristic positional nystagmus.
authors: Department of Otorhinolaryngology, Hino Municipal Hospital, 4-3-1 Tamadaira Hino-shi, Tokyo, Japan. amifumi@bc5.so-net.ne.jp
authors: Fumiyuki
authors: F
authors: Goto
authors: Tomoko
authors: T
authors: Tsutsumi
authors: Iwao
authors: I
authors: Nakamura
authors: Kaoru
authors: K
authors: Ogawa
mesh_terms: D000368:Aged; D065635:Benign Paroxysmal Positional Vertigo; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D004244:Dizziness / Q000209:etiology*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D019462:Syncope, Vasovagal / Q000209:etiology*; D014012:Tinnitus / Q000209:etiology*; D014717:Vertigo / Q000175:diagnosis / Q000209:etiology*; D014724:Vestibular Function Tests