Syncopal events are a concerning presentation and timely evaluation is warranted. Common aetiologies include cardiac and neurological pathology such as arrhythmias, vertebrobasilar arterial disease and vasovagal syncope. We describe the case of a 65-year-old man who presented to our emergency department with symptoms of vertigo and syncope. He was investigated extensively for both cardiac and neurological causes of his symptoms which returned negative results. An outpatient CT scan demonstrated the presence of Os odontoideum and dynamic instability of the atlantoaxial junction, with presumed dynamic obstruction of the vertebral arterial system. This was successfully managed with a posterior atlantoaxial lateral mass fusion with resolution of syncopal symptoms.
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Contributors CSB conducted a history and examination of our patient and researched and wrote the body of the report. AD conducted a further evaluation of our patient to confirm findings; provided further research to aid literature review; edited the initial draft. HS edited the second draft and confirmed findings in retrospect, advised template, provided imaging. HS also helped in arranging meetings with our patient for consent. SK directed the overall report, provided supervision regarding the design of the report, illustrating the important points of the case and providing a final edit of the draft prior to submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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