Abstract 11318: A Rare Case of Stretch Syncope of Adolescence Masquerading as Carotid Artery Dissection and Carotid Sinus Syndrome

Abstract

Introduction: Syncope describes a brief, sudden loss of consciousness and tone, with spontaneous return to baseline. Although episodes arise from a transient interruption of cerebral blood flow, work-up identifying an underlying is critical, as it can determine the proper treatment for cessation of these episodes. In this case, we describe a patient who was later diagnosed with stretch syncope of adolescence (SSA), a rarely reported cause of syncope. Case Presentation A 16-year-old male presented to the E.R. after experiencing a syncopal event immediately after looking up. He endorsed a similar episode one week earlier, after standing and looking up. The patient also revealed that he commonly would crack his neck and would often sleep with his head extended over the arm of his couch. In the E.R., the patient was hypotensive to 107/62 mmHg, but physical exam and lab work-up did not reveal any significant pathology. EKG and a CT head without IV Contrast showed no acute intracranial abnormality. Soon after admission, he became bradycardic, hypotensive, and lightheaded. Due to concern for carotid artery dissection, bilateral carotid duplex scan and CT of the head and neck were completed, and given the reproducibility of the patient’s symptoms with neck dorsiflexion, an MRI to evaluate for carotid sinus syndrome was completed. All imaging, however, returned unremarkable. Given the patient’s age, symptom onset with movement, and exclusion of other etiologies, a diagnosis of SSA was made. The patient was discharged with strict instructions to avoid stretching, especially when standing. Discussion SSA is characterized by episodic loss of consciousness triggered by a combination of stretching and neck hyperextension. It is a rarely reported phenomenon, with only 14 case reports published on SSA as of 2014, and is often confused with more common syndromes, most commonly epileptic seizures. Our case is especially unique because the patient’s presentation was initially most consistent with carotid artery dissection and coronary sinus syndrome, a previously unreported presentation. By continuing to recognize and report cases such as ours, patients with SSA may receive more prompt diagnosis, avoid extraneous work-up, and ultimately, prevent future syncopal events.