Syncope, Urinary Retention, and Neuropathy in a 40-Year-Old

Amanda Kennedy, MD, MPH; Jeffrey Kaplan, MD; Dianna Quan, MD


February 27, 2023

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A 40-year-old man is referred for neurologic evaluation after presenting with peripheral neuropathy. Three years ago, he noted numbness, burning pain, and reduced temperature sensation in his feet. For the past 2 years, he has had dry eyes and dry mouth; urinary retention that requires self-catheterization; gastrointestinal symptoms, including alternating diarrhea and constipation; and nausea. His weight has decreased by 40 lb (18.1 kg) over 12 months. He has noticed decreased sweating. He also reports erectile dysfunction.

For several months, he has had frequent syncopal episodes triggered by positional change. In hindsight, he reports intermittent dizziness associated with a "daydreaming" feeling that began 8 years ago; however, these spells were not associated with loss of consciousness. He was also recently diagnosed with Sjögren syndrome.

He reports no chest pain, palpitations, shortness of breath, or edema. A review of systems is otherwise unremarkable. His past medical history is notable for hypothyroidism. His family history is notable for a grandfather who had gastrointestinal problems and a sister who has palpitations. His parents are alive and have no neurologic symptoms. He takes no medications or supplements.


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