To Study Vitamin B12 Deficiency and Response to Treatment in Patients Presenting With Vasovagal Syncope

Objectives: Tilt table testing is widely used in the clinical evaluation of patients presenting with syncopal symptoms. As Vitamin B12 deficiency presents with various neurologic symptoms and signs including orthostatic hypotension and rarely syncope, it is hypothesized that Vitamin B12 deficiency may be related to the development of vasovagal syncope. Methods: 35 patients with recurrent syncope or first episode of syncope in whom vasovagal syncope was suspected were included. Results: A total of 153 patients with suspected vasovagal syncope were referred for Head-Up Tilt Test. Out of the 153 patients, 89 showed a ‘positive' response to Tilt test and remaining 64 with ‘negative' response were excluded. 50 of the 89 patients with a ‘positive' response gave their written informed consent and were enrolled. Serum Vitamin B12 was measured at baseline in these 50 patients, of which 35 were found to be deficient and these were finally included. All deficient patients were supplemented with Vitamin B12 and Tilt test was repeated after 1 and 6 month periods after documenting Vitamin B12 sufficiency. At 1 month, 14 patients demonstrated a negative Tilt test with this number increasing to 17 on 6 month follow up. Conclusion: Supplementation of Vitamin B12 in deficient patients presenting with suspected Vasovagal syncope resulted in significant improvement in symptoms at 1 and 6 months of follow up. Vitamin B12 deficiency may be linked to Vasovagal syncope and all patients with suspected Vasovagal syncope should have their Vitamin B12 levels tested and supplementation given if found to be deficient.