Noemi Motta

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IntroductionSyncope is a transient, self-limiting loss of consciousness and an inability to maintain postural tone due to reduced cerebral blood flow, which is followed by spontaneous recovery. Affecting 1-3% of the elderly population, it represents a challenging problem in medical practice because the causal mechanism often remains uncertain even after extensive and expensive evaluations.1 Syncope may be caused by a variety of factors, including cardiovascular, neurological, and metabolic disorders, and its presentations are quite variable. However, the most common causes of syncope are neurocardiogenic or vasovagal syncope, which account for up to 50% of cases.1 This type of syncope is typically triggered by emotional distress, pain, or orthostatic stress and is characterized by a sudden drop in blood pressure and heart rate. In the literature, some authors have described cases of “vestibular syncope” in which vertigo may cause syncopal attacks.2,3 However, the term “vestibular syncope” determined a lot of confusion since it has been ascribed to completely different vestibular conditions, varying from dizziness4 to Tumarkin in Menière disease (MD),5 in which the patients experienced a severe immediate drop episodes without loss of consciousness.6 The same term has also been ascribed to the neurovegetative symptoms in benign paroxysmal positional vertigo (VPPB) or fainting after otholitic maneuvers.7Vestibular syncope has also been addressed in the non-autonomic neurological causes of syncope8 and in central vertebrobasilar hyperfusion.9