Refractory Syncope and Presyncope Associated with Atlantoaxial Instability: Preliminary Evidence of Improvement Following Surgical Stabilization
| Autor: | Malini Narayanan, Kelly Tuchmann, Fraser C. Henderson, Clair A. Francomano, Robert Rosenbaum, Myles Koby, Peter C. Rowe |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Joint Instability Male Down syndrome Lightheadedness Adolescent Syncope 03 medical and health sciences Young Adult 0302 clinical medicine medicine Humans Retrospective Studies Presyncope biology business.industry Incidence Syncope (genus) Dysautonomia Retrospective cohort study Middle Aged medicine.disease biology.organism_classification Atlanto-Axial Joint Atlantoaxial instability 030220 oncology & carcinogenesis Rheumatoid arthritis Anesthesia Surgery Female Spinal Diseases Neurology (clinical) medicine.symptom business Tomography X-Ray Computed 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 149 |
| ISSN: | 1878-8769 |
| Popis: | The proclivity to atlantoaxial instability (AAI) has been widely reported for conditions such as rheumatoid arthritis and Down syndrome. Similarly, we have found a higher than expected incidence of AAI in hereditary connective tissue disorders. We demonstrate a strong association of AAI with manifestations of dysautonomia, in particular syncope and lightheadedness, and make preliminary observations as to the salutary effect of surgical stabilization of the atlantoaxial motion segment.In an institutional review board-approved retrospective study, 20 subjects (16 women, 4 men) with hereditary connective tissue disorders had AAI diagnosed by computed tomography. Subjects underwent realignment (reduction), stabilization, and fusion of the C1-C2 motion segment. All subjects completed preoperative and postoperative questionnaires in which they were asked about performance, function, and autonomic symptoms, including lightheadedness, presyncope, and syncope.All patients with AAI reported lightheadedness, and 15 had refractory syncope or presyncope despite maximal medical management and physical therapy. Postoperatively, subjects reported a statistically significant improvement in lightheadedness (P = 0.003), presyncope (P = 0.006), and syncope (P = 0.03), and in the frequency (P0.05) of other symptoms related to autonomic function, such as nausea, exercise intolerance, palpitations, tremors, heat intolerance, gastroesophageal reflux, and sleep apnea.This study draws attention to the potential for AAI to present with syncope or presyncope that is refractory to medical management, and for surgical stabilization of AAI to lead to improvement of these and other autonomic symptoms. |
| Databáze: | OpenAIRE |
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