Abstract Details

Title Reflex syncope as cause and effect of concussion related dysautonomia in a collegiate athlete

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P10 - Poster Session 10 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-006

Objective The objective of this report is to highlight difficulties in diagnosing reflex syncope and share examples of how it relates to concussion and sports neurology.

Background The differential for neurally mediated reflex syncope includes both vasovagal syncope and potentially dangerous cardiovascular disorders(Weiling, 2004). The diagnostic evaluation process is very important when considering reflex syncope as a diagnosis and includes taking a good history and performing a thorough physical examination (Benditt, 2019). Autonomic dysfunction can occur following concussion (Esterov, 2017). Both reflex syncope and post-concussive dysautonomia present with subjective symptoms and can result in abnormal autonomic testing.

Design/Methods A 21-year-old female lacrosse player presented with four years of loss of consciousness events related to playing sports. The frequency of events increased over time and were related to intense practices or game play. Events had no prodrome and short periods of post-ictal confusion. Many events caused the patient to fall on the ground, subsequently have concussion symptoms, notably feeling in a fog and lightheaded with standing. Extensive workup was negative including cardiovascular testing (Table 1), imaging of brain (Figure 1), EEG (Figure 2), and endocrinology screening (Table 2). Autonomic testing was abnormal (Table 3) because tilt-table revealed pre-syncopal symptoms with hypotension and without tachycardia at 18 minutes. Midodrine was used without effect. Over two years, the patient’s symptoms became more stereotyped and were triggered by stretching her neck up and to the right (Figure 3). This confirmed a diagnosis of reflex syncope.

Results The patient underwent physical therapy and developed subjective methods for identifying near symptoms and maneuvers to prevent loss of consciousness when syncopal events began during high-intensity performance.

Conclusions Undiagnosed reflex syncope can contribute to multiple concussions due to repeated fainting during exercise. Dysautonomia should be scrutinized as an effect or cause of a student athlete's concussion profile.

Authors/Disclosures
Paige Buddenhagen PRESENTER	No disclosure on file
Kate M. Essad, MD, FAAN	Dr. Essad has nothing to disclose.

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