Herniated cerebellar tonsils and cough syncope

Abstract

✓ Two patients with cough syncope and herniated cerebellar tonsils apparently of congenital origin are reported. Neither had hydrocephalus or any evidence of neoplasm. Tests were done in one patient during coughing: the resting cerebrospinal fluid pressure fell; the transmitted pulse pressure waves disappeared; hypotension, bradycardia, and occipital headache developed; and evoked potential amplitude was markedly reduced. All findings returned to control values within 2 minutes. After suboccipital craniectomy and upper cervical laminectomy, neither patient has had recurrence of cough headache or of cough syncope. A mechanism for this event is suggested.