Vasovagal Syncopy (Feinting)- A case study

An Interesting case of Vasovagal Syncopy Or the problem of consistently feinting while eating.

A patient complained that for the last few years she was having enormous difficulty with swallowing. Often during a meal she would ‘pass out’, her record was five times during a meal, literally ‘face planting’ onto her plate. It was very distressing for her and everyone around her. They would hold onto her while she ate waiting for the ‘drop’. Even swallowing her own saliva while walking around could lead to a fall and injuries. Once, occasioning a fall down a flight of stairs.

Driving was a problem as she had to pull over to have a drink of water, prepare herself for an episode of unconsciousness, recover and drive off as if nothing had happened.

Vasovagal Syncopy is a very interesting phenomena. Basically the nervous system doesn’t co-ordinate properly allowing a temporary drop in blood pressure to the brain. It then shuts down leading to unconsciousness. For some inexplicable reason the blood needed to pump up to the brain tends to pool in the legs.

It is known to occur for a variety of common reasons such as :

• Standing still in the hot sun
• Heat exposure
• Seeing blood or having an injection
• Fear
• Straining at the stool.

There is a variation of it called Micturition Syncopy where older men ‘pass out’ while urinating.

Anyway the lady who ‘swallows’ to initiate this phenomena was typical in some ways and very different in others. She had been to multiple physicians without any hope of a treatment. The usual medical advice for this problem is to ‘work around it’ ie, there isn’t any medication or therapy utilised as ‘best practice’. It is usually a matter of putting up with it.

From another point of view this problem is a lack of fine co-ordination of the heamodynamics that we all normally have. Basically the receptors that convey messages of how much pressure the heart must pump in various situations, or the vascular response of the lower limbs, is not working properly, or both. Either way the nervous system is dysfunctional but not pathologic. Vasovagal Syncopy wont kill someone by itself. Of course, if the environment is dangerous, passing out could end up being fatal!

This patient’s history was unremarkable and did not give any clues as to the source of her issue. A bank of tests to do with her Autonomic Nervous System revealed enough aberrant or unusual findings to start to get an idea as to what might be going on with her.

The Carotid Sinus Reflex was sluggish and largely unresponsive compared to normal. This is a test that requires measurement of the Heart Rate before and after light finger pressure upon the carotid sinuses in the neck. The occulo-cardiac reflex was similar. Gentle pressure upon the closed eyeball also affects the Heart Rate. This also was slow to respond and didn’t vary as much as normal.

More generally the evaluation of Eye Movements using Saccadometry showed a poor cerebellar control.

• Dynamic Visual Acuity Testing showed a poor Vestibulo-occular Reflex.
• Force Plate Analysis also showed ocular deficiency and poor proprioception integration.

Together these findings led to a formulation of a treatment regime which included:

• Spinal Adjustments which are proven to stimulate the Frontal Cortex of the Brain
• Low Level Electrical Stimulation of the tongue to gently stimulate the Brain Stem
• Sensory-motor integration procedures using Laser Guided Targeting and Hand-eye co-ordination and timing techniques.
• Observing Saccades and Pursuits.

Also home exercises were emphasised utilising:

• Gargling
• Singing loudly
• Standing on one foot while teeth brushing with eyes closed.
• Gaze stabilisation exercise
• Deep Knee Bends (squats)

After 5 consultations in one month we were happy to hear that the problem of feinting with swallowing was completely gone.

A very interesting case.