Recurrent syncopal events preceded by transient abnormal gait disturbance

A previously fit and well patient in his 70s presented after recurrent transient loss of consciousness following dinner with alcohol consumption. Each event has been preceded by several minutes of transient abnormal posture and gait. More specifically, there were several minutes of stiffening of legs, shuffling gait and gait ataxia. Initial clinic investigations, including ECG, echocardiogram, CT and MRI head scans, vestibular tests and biochemistry for vitamins and electrolytes, proved inconclusive. However, a positive tilt table test demonstrated severe orthostatic hypotension (OH) with loss of consciousness. Acute alcohol consumption worsens OH, and prolonged hypotension can potentiate cerebral hypoperfusion leading to syncopal events. Compromise to posterior circulation during these events may cause transient gait abnormalities. Such cases have not been widely documented in the literature. Transient gait disturbance in syncope remains underexplored. Further research and documentation are needed, informing better diagnostic and management strategies.