Abstracts

Rationale: we report 3 cases of losing of consciousness brought by over stretching of the back and the neck. Use of video EEG has not been mentioned before to diagnose such episodes and differentiate them from epilepsy. Methods: History, physical examination, neuroimaging, and EEG data were reviewed for each patient. Results: 3 adolescent males age 14 and 16- years developed recurrent syncope after back and neck hyperextension. Lost consciousness followed extending the arms up while yawning and hyperextending the neck and back. Within seconds, each became light headed and off balance, with blurred vision, and, if standing, lost consciousness for a few seconds. If sitting, repositioning the head forward prevented loss of consciousness, with amelioration of symptoms within seconds. A generalized tingling from the neck down, lasting about 5 seconds, followed recovery of consciousness. One family member had recurrent syncope. all patients had normal cervical and cranial MRI and cardiologic assessments. With MRA, one had a tortuous, redundant, left distal vertebral artery in which there was reduced blood flow only seen with head and neck placed in hyperextension. The others had normal MRA with neck only in a neutral position. Using Vedio EEG monitorining we were able to record the sequence of events leading to loss of consiosness. EKG recordinding showed bradycardia. EEG showed ganeralized slowing of the background without epileptiform discharges. Conclusions: The cases narrated highlights the utility of video EEG in differentiating epileptic versus nonepileptic events. There are two Adolescent Stretch Syncope citations in the Neurology literature and none in the Pediatric Neurology literature. This disorder is thought to either represent a vasovagal event or a consequence of structural obstruction of posterior circulation blood flow. Our data suggests that obstruction to flow in the posterior circulation contributes to the occurrence of Adolescence Stretch Syncope. The entity is benign and treatment is directed at avoidance of the provocative posture.