Postprandial Dizziness/Syncope Relieved by Alfa-Glucosidase Inhibitor: A Case Report / 대한평형의학회지

A 74-year-old man presented with positional vertigo and prandial dizziness and syncope. He had experienced episodes of frequent dizziness and loss of consciousness for several months. He underwent total gastrectomy with esophagojejunostomy and brown anastomosis 30 years ago. Thirteen years ago, subtotal colectomy with ileo-descending colostomy was done due to colon cancer. And he also had mitral valve replacement and maze operation due to severe mitral valve stenosis and atrial fibrillation. After cardiac operation, he has suffered from sudden dizziness with diaphoresis and chalky face, which usually occurs especially within 30 minutes from the onset of eating. Sometimes, this event was followed by several seconds of loss of consciousness, which caused recurrent events of falling. Neurological examination showed positional nystagmus compatible with benign paroxysmal positional vertigo arising from posterior semicircular canal of the right ear. The positional vertigo disappeared immediately after canalith repositioning maneuver. We tried to monitor vital signs and serum level of glucose during eating. Hyperglycemia (range, 210–466 mg/dL) was noted during eating, which was accompanied by postprandial and prandial hypotension, up to 60/40 mmHg. The patient was prescribed 100 mg of the alfa-glucosidase, acarbose to be taken half an hour before each meal. Eventually, the treatment with acarbose ameliorated the prandial dizziness and hypotension associated with hyperglycemia. Our patient suggests the acarbose could prevent postprandial dizziness and hypotension.

A case of postprandial hypotension presenting with postprandial dizziness / 대한내과학회지

Postprandial hypotension is an important minor clinical problem. It is a common disorder that causes unexplained dizziness, falls, lightheadedness, syncope, angina pectoris, and even transient ischemic attacks of the brain. It is often defined as a decrease in systolic blood pressure by more than 20 mmHg within 2 hours after a meal. The mechanism of postprandial hypotension is splanchnic blood pooling via the loading of glucose in the intestine and decompensation of the autonomic nervous system. The best tool for detecting a fall in systolic blood pressure is 24-hour ambulatory blood pressure monitoring. Acarbose, an alpha-glucosidase inhibitor, is very useful for preventing postprandial hypotension. We experienced a case of postprandial hypotension that presented with postprandial dizziness. The patient was treated successfully with acarbose before each meal.