@article{ref1,
title="Vestibular syncope: clinical characteristics and mechanism",
journal="Annals of clinical and translational neurology",
year="2022",
author="Kwon, Hanim and Kwon, Eunjin and Kim, Hyo-Jung and Choi, Jeong-Yoon and Kim, Ji-Soo",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND AND OBJECTIVES: Vestibular syncope is a condition in which vertigo-induced hemodynamic changes cause syncope. This study investigated the clinical and laboratory findings of vestibular syncope and tried to refine our knowledge of the mechanism underlying this newly recognized entity. <br><br>METHODS: This study retrospectively analyzed 53 patients (33 women, median age = 63 years [interquartile range = 54-71 years]) with vestibular syncope from January 2017 to December 2021. To explain the mechanism of vestibular syncope, we incorporated a velocity-storage model into the dual reflex pathways comprising the vestibulo-sympathetic reflex and baroreflex and predicted the cardiovascular responses. <br><br>RESULTS: Twenty (37.7%) patients had multiple episodes of vestibular syncope, and seven (13.2%) had potentially life-threatening injuries. Meniere's disease (20.8%) and benign paroxysmal positional vertigo (9.4%) were the most common underlying vestibular disorders. Abnormal vestibular function tests included impaired cervical vestibular-evoked myogenic potentials (57.5%) and positive head impulse tests (31.0%). Orthostatic hypotension was found in 19.5% of patients. Dyslipidemia (30.2%) and hypertension (28.3%) were common medical comorbidities. The dual reflex pathways incorporating the function of the velocity-storage circuit in the brainstem and cerebellum suggest that vestibular syncope is a neurally mediated reflex syncope associated with a sudden hemodynamic change during vertigo. This change can be arterial hypertension triggered by a false downward inertial cue, as suggested previously, or hypotension driven by a false upward inertial cue. <br><br>CONCLUSIONS: Vestibular syncope is associated with various vestibular disorders and requires careful evaluation and intervention to prevent recurrent falls and significant injuries.<p /> <p>Language: en</p>",
language="en",
issn="2328-9503",
doi="10.1002/acn3.51661",
url="http://dx.doi.org/10.1002/acn3.51661"
}