Differential Diagnosis for Syncope when Turning Head

• Single most likely diagnosis
  • Vasovagal Syncope: This condition is often triggered by specific stimuli, such as turning the head, which can lead to a sudden drop in heart rate and blood pressure, resulting in syncope. The mechanism involves a reflex of the autonomic nervous system that can be triggered by various stimuli, including certain movements or positions.
• Other Likely diagnoses
  • Orthostatic Hypotension: Although more commonly associated with standing up, certain positions or movements, like turning the head, can exacerbate or trigger orthostatic hypotension in susceptible individuals, leading to syncope.
  • Cervical Spondylosis or Cervical Spine Disease: In some cases, turning the head can compromise blood flow through the vertebral arteries, especially if there is significant cervical spondylosis or other cervical spine disease, potentially leading to syncope.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Vertebrobasilar Insufficiency: This condition involves transient ischemic attacks in the posterior circulation and can be triggered by head movements that compromise blood flow through the vertebral arteries. Missing this diagnosis could lead to a stroke.
  • Carotid Sinus Hypersensitivity: Abnormal sensitivity of the carotid sinus can lead to profound bradycardia and hypotension in response to certain stimuli, including neck movements, potentially causing syncope.
• Rare diagnoses
  • Subclavian Steal Syndrome: A rare condition where there is a significant stenosis or occlusion of the subclavian artery proximal to the origin of the vertebral artery, leading to reversal of blood flow in the vertebral artery when the arm is exercised or in certain positions, potentially causing syncope.
  • Chiari Malformation: Although primarily associated with symptoms like headache and neck pain, in rare cases, a Chiari malformation can lead to brainstem compression and alterations in cerebrospinal fluid dynamics, potentially causing syncope with certain head movements.