# Postural Orthostatic Tachycardia Syndrome Presenting With Recurrent Syncope After Cervical Spinal Cord Injury

## TL;DR

A man with a C2 spinal cord injury developed syncope due to postural orthostatic tachycardia syndrome, highlighting autonomic dysfunction risks.

## Contribution

This case report highlights POTS as a rare but significant cause of syncope after high cervical spinal cord injury.

## Key findings

- POTS can manifest as syncope in patients with C2 spinal cord injury.
- Heart rate variability and sympathetic skin response assessments aid in diagnosing autonomic dysfunction.
- Comprehensive rehabilitation management can resolve syncopal episodes effectively.

## Abstract

Syncope is a manifestation of autonomic dysfunction after high spinal cord injury. However, it is rarely reported as a feature of postural orthostatic tachycardia syndrome (POTS) after spinal cord injury. This case report describes a male in his 50s suffering from C2 spinal cord injury who developed recurrent postural syncope post‐injury. These events were characterized by orthostatic tachycardia upon standing and could even be induced by seated head‐tilt maneuvers, fulfilling the diagnostic criteria for POTS. These patients have substantial risks of fall‐related morbidity. Heart rate variability and sympathetic skin response assessments help elucidate the underlying autonomic pathophysiological mechanisms. Syncope may be the predominant symptom during transfers, standing, or seated head‐tilt positioning. Notably, documenting heart rate fluctuations during transient syncopal events is challenging. Infections constitute established triggers for syncope. Comprehensive management strategies may achieve complete resolution of syncopal episodes.

Postural orthostatic tachycardia syndrome can occur after high cervical spinal cord injury, even in patients with an American Spinal Injury Association Impairment Scale grade of D. Recurrent syncope during rehabilitation may be the predominant manifestation, and both heart rate variability and sympathetic skin response may facilitate and support identification of autonomic dysfunction. Comprehensive rehabilitation management demonstrates favorable therapeutic outcomes.