Abstract

An undescribed association between syncope and Raynaud's disease is presented. Ten females and one male, aged 19–64 years, with syncope and Raynaud's disease were seen over a period of 6 years. The features in all suggested brainstem syncope. Nine had active, and one a history of, migraine. Three had previous diagnoses of non-epileptic attack disorder (psychogenic seizures). Syncope and Raynaud's disease improved in parallel, in all patients, after treatment with a calcium channel blocker (Nifedipine). Migraine also improved in five patients. A chance association between syncope and Raynaud's disease is statistically unlikely, and a pathophysiological link between the two is explored. Syncope in this condition may result from transient brainstem ischaemia, and brainstem spreading depression might also be involved. Syncope is relatively common, but the cause is unknown in more than one-third of patients. The association described here is important in establishing an exact diagnosis in some patients with syncope, and in providing new treatment options.