Postural tachycardia syndrome in syringomyelia: response to fludrocortisone and beta-blockers

Orthostatic intolerance is occasionally reported by patients with syringomy elia and is usually attributed to vestibular symptoms or neurogenic orthost atic hypotension. Postural tachycardia syndrome has not been previously des cribed in syringomyelia. A patient with long-standing syringomyelia and a C hiari type I anomaly developed disabling "panic-like" attacks associated to orthostatic intolerance five years after posterior fossa decompression and shunting of the syrinx. A head-up tilt test showed an early phase of postu ral orthostatic tachycardia followed by progressive arterial hypotension an d bradycardia as seen in neurally mediated syncope. A magnetic resonance im aging scan showed a collapsed syrinx from the 3rd cervical to the 12th thor acic vertebra without syringobulbia. Fludrocortisone and beta -blockers led to resolution of symptoms. Partial sympathetic denervation of the legs in syringomyelia might explain the occasional occurrence of postural tachycard ia syndrome. Postural tachycardia syndrome may be included as a possible ca use of orthostatic symptoms in syringomyelia patients.