I have read with interest the letter recently published on Repeated syncopes and extended paediatric hydrosyringomyelia/Chiari I malformation.1 The case reported is quite unusual, as syncope seems to be a very rare manifestation of this condition, even when associated with a Chiari malformation, at least in adults. From a series of 100 adult patients with syringomyelia diagnosed over the past 10 years at this institute, two thirds of whom had an associated Chiari type I anomaly, only one patient had syncope, which was triggered by sneezing. Another three patients had drop attacks without loss of consciousness, one with a Chiari type I anomaly, and two with an associated ventricular dilatation (figure).