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Original Contributions |

Syncope and Raynaud’s Disease

Roberto J. Guiloff, MD, FRCP; Sanjeev Rajakulendran, PhD, MRCP; Heather Angus-Leppan, MD, FRCP
Arch Neurol. 2012;69(5):608-613. doi:10.1001/archneurol.2011.1168.
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Objective To investigate an association between syncope and Raynaud’s disease (RD), its clinical features, and the effect of treatment with nifedipine.

Design One-year prospective study of new outpatients after 3 initial clinical observations.

Setting Neurology clinics at Chelsea and Westminster, Royal Free, Barnet, and Edgware Hospitals.

Patients Ten women and 1 man. The group had a mean (SD) age of 33 (17) years. Mean (SD) follow-up was 24 (36) months.

Intervention Treatment with nifedipine.

Outcome Measures Observed vs expected frequency of syncope in RD, temporal relation between syncope and Raynaud’s phenomenon, clinical features, and response to nifedipine treatment.

Results Eight additional patients with syncope and RD were identified from 603 new patients (1.3%); we had expected only 1 patient to be identified with syncope and RD (P = .003). A chance association between RD and migraine with recurrent syncope was unlikely (P = .01). The prevalence of RD in patients with syncope with migraine was higher than expected (P = .03), but that of migraine in patients with RD was not (P = .2). All 11 patients had 5 or more syncopal episodes for a median of 2 years (range, 0.1-62 years). Three patients had previous diagnoses of nonepileptic attacks. Syncope was preceded by or contemporaneous with Raynaud’s phenomenon in 10 patients (P = .02). Nine patients had migraine; headache was contemporaneous with syncope in 4 patients as expected by chance (P = 1.0). In all patients, syncope was preceded by brainstem or vertebrobasilar symptoms, and it ceased after treatment with nifedipine. Raynaud’s disease and migraine improved less.

Conclusions The association of syncope to RD was unrelated to chance or migraine. The temporal relation between syncope and Raynaud’s phenomenon but not headache was statistically significant. Treatment with nifedipine stopped recurrent syncope in all patients. Syncope related to RD may result from brainstem ischemia. Unexplained recurrent syncope should prompt screening for RD.

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