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Neck pain & syncope

      Re: Neck pain & syncope

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Posted by CCF MD GS on February 23, 1998 at 09:30:45:

In Reply to: Neck pain & syncope posted by Mary on February 19, 1998 at 14:16:57:

: Thank you in advance for your insights.  I'll try to keep this brief and to
  the point.  
  I'm 34 years old and of overall great health.  For the last several years,
  though, I've been experiencing a strange problem with my neck, though, that's
  become progressively worse over time.  
  I'm having varying degrees of pain on the left side of my neck when I turn
  my head in any direction or reach for something with both arms. The feeling,
  in my layman terms, is like a tendon or ligament is "popping out of place",
  and I can usually hear a clicking type of noise.  The pain can be mild to
  severe, and will often radiate up to my left ear and/or down to my collar bone.
  It isn't in my jaw area, rather more localized around the muscles and tendons
  that run down the side of my neck, toward the front.  Sometimes I'll get a
  feeling like they're rubbing together, kind of a grating type of sensation.
  When the pain is bad it's like a knife peircing my neck, but only lasts for
  a second or two at the most.
  The main problem is that I'm experiencing episodes of syncope with these
  painful neck sensations.  It doesn't happen all the time, though I experience
  these symptoms every day, some worse than others.  I've been passing out about
  once every couple of months, and it's always after a particularly painfull
  episode of the neck pain, which is always after I've turned my head or reached
  out for something with my arms.  Presyncope is quite common, at least once
  a week, with feelings of lightheadedness, heart racing, and sometimes ear ringing.
  My doctors, bless them, have tried everything they know.  MRIs look normal.
  Eagles Syndrome has been ruled out because I don't have an elongated styloid
  process.  One interesting note, though, is that during an arteriogram the
  radiologist commented that I had "tiny vertebral arteries".  It was also shown,
  during a doppler study, that the blood flow through both my carotid and vertebral
  arteries dropped a marked amount when I'd turn my head in either direction.
  Early on I was diagnosed with epilepsy because each time I passed out I'd
  exhibit seizure type movements.  This diagnosis was eventually retracted
  when none of the antiseizure medications blocked the episodes.  I also had
  to keep insisting that this was all related to a tendon or ligament moving
  in my neck, whether that makes sense or not.
  It was recommended that I wear a soft cervical neck collar, and this does
  help tremendously.  If I don't move my neck I don't experience the pain!  
  But I'd like to get to the bottom of this if at all possible, and know what's
  Any thoughts?  Thanks for the help!
Thanks for the intersting question. Sounds like you are having vasodepressor syncope. I'm not sure it has anything to
do with vascular supply but the pain itself. If you have had extensive imaging studies and an angiogram to rule out the
bad things then it is probably not related to an anatomical problem. It is not unusual for people that pass out to jerk their
arms or legs and have these confused with seizures. It seems to that the best treatment at this time would be to concentrate on
treating the neck pain as the focal point. This can be done with physical therapy and or trigger point injections. If this is not satisfactory
in terms of end point we could also have you referred to our autonomic lab at the Cleveland Clinic run by
Dr. Shields. Abnormalaties of the baroreceptors (pressure regulators that sit in the neck) can cause fluctuations in blood pressure control.
If you wish a referral to CCF cal 216 444 5559.
This information is provided for general medical education purposes only. Pleaes consult your physician for diagnostic and treatment options of your specific
medical condition.

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