Syncopal events are a concerning presentation and timely evaluation is warranted. Common aetiologies include cardiac and neurological pathology such as arrhythmias, vertebrobasilar arterial disease and vasovagal syncope. We describe the case of a 65-year-old man who presented to our emergency department with symptoms of vertigo and syncope. He was investigated extensively for both cardiac and neurological causes of his symptoms which returned negative results. An outpatient CT scan demonstrated the presence of Os odontoideum and dynamic instability of the atlantoaxial junction, with presumed dynamic obstruction of the vertebral arterial system. This was successfully managed with a posterior atlantoaxial lateral mass fusion with resolution of syncopal symptoms.

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Subarachnoid hemorrhage due to cerebral aneurysm rupture is a devastating event with a high mortality and significant morbidity. The safety of patients undergoing electroconvulsive therapy (ECT) in the presence of an aneurysm is not clear and is a cause of anxiety for both health care workers and patients. The present article collated the available evidence related to ECT in the presence of an aneurysm and found that there were no case reports where ECT directly led to the rupture of an aneurysm, although 1 case reported a rupture of an aneurysm between sessions of ECT. The epidemiology of cerebral aneurysms is discussed, as are key clinical considerations related to the care of patients with aneurysms who require ECT.