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Syncope on swallowing.

A 29-year-old housewife had for about four years experienced several ' dizzy' attacks while swallowing. The attacks were essentially stereotyped but varied in duration. She first noticed blurring of vision followed rapidly by a sensation of fainting, and she would collapse to the floor if standing. Loss of consciousness for a brief duration occurred on a total of eight occasions. She remembered the fall, and witnesses did not notice any epileptic phenomenon. On two occasions she had suffered minor injuries and once dropped her baby from her arms. Minor attacks, consisting mainly of blurring of vision and fainting, were much more frequent and latterly had been occurring at each meal or in between if she happened to swallow even a piece of chocolate. There was, however, no relation with the size, consistency, or temperature of the bolus. The symptoms were worse when standing. Over the preceding year she had also been aware of food sticking at about the level of the manubrium sterni. In view of this unusual history, the absence of any clinically detectable abnormality, and normal results from routine investigations, she was referred to one of us (P.H.G.) for a psychiatric opinion.