Abstract Introduction Syncope is transient loss of consciousness (TLOC) caused by self-limited global cerebral hypoperfusion. It can be caused by factors like reflex faints, orthostatic hypotension, or cardiac arrhythmias. Evidence suggests Stretch-Induced Syncope (SS) is a rare form of reflex situational syncope, triggered by neck extension and shoulder abduction Figure 1. Purpose To synthesize the existing literature on SS, highlighting its diagnostic challenges, potential mechanisms, and management strategies Methods A comprehensive literature review was conducted using PubMed, Google Scholar, and Scopus databases, with multiple search terms to capture all "Stretch Syncope." Inclusion criteria were full-text articles published in English, focusing on stretch-induced syncope. After screening 133 articles, 12 met inclusion criteria and were selected for analysis Figure 2. The selected literature comprised case reports (n=21) but 7 also discussed diagnostic methods, and 7 proposed pathophysiological mechanism. Results A total of 21 patients (ages ranging from 5 to 26 years) from 11 case reports were included. The most common symptoms were dizziness, lightheadedness, and TLOC, all of which were triggered by neck hyperextension or arm stretching. A diagnostic challenge was distinguishing these episodes from seizures, as myoclonic jerks often occurred during reported TLOC events. Diagnostic tests included Video-EEG, Holter-ECG, and blood pressure (BP) assessment by finger plethysmography. The latter, obtained in 5 cases revealed transient hypotension (typically a drop of 40-60 mmHg in systolic BP). Video-EEG was reported in 7 cases and revealed delta wave slowing suggestive of cerebral hypoperfusion. Compensatory tachycardia during stretching was observed in 11 cases. Doppler ultrasound of both transcranial and extracranial vessels showed an inconsistent pattern that were interpreted to suggest compression of the carotid and proximal vertebral arteries during neck movement. The principal proposed mechanisms for the SS symptoms included vertebral artery compression or a carotid baroreceptor-like vasodepressor reflex. However, the former would not be expected to diminish cerebral blood flow if the carotid arteries are not obstructed, and carotid hypersensitivity is a low probability in that the affected population tends to be young and unlikely to exhibit the requisite carotid sinus hypersensitivity. Treatment focused on avoiding movements that trigger symptoms, with some patients benefiting from cognitive behavioral therapy (CBT). Conclusion SS is a rare but clinically important condition that comprises TLOC triggered by certain neck and arm movements. SS is often overlooked or misdiagnosed, highlighting the need for awareness. The pathophysiology of SS remains unclear. Further research with larger cohorts and standardized protocols is essential to improve understanding and refine treatment strategies.
Keller et al. (Sat,) studied this question.