BACKGROUND
Hair-grooming syncope is a rare form of situational reflex syncope, reported mainly in children and adolescents. Routine neuroimaging is not recommended in uncomplicated syncope with a normal neurological examination but can reveal incidental findings.
CASE REPORT
A previously healthy 22-year-old man had 2 consecutive syncopal episodes, preceded by dizziness, during hair washing at a barbershop with forward neck flexion. Vital signs, neurological examination, electrocardiography, laboratory tests, and cranial computed tomography were normal; orthostatic blood pressure was not measured. Brain magnetic resonance imaging showed a 2.5-cm extra-axial lesion in the quadrigeminal cistern with marked diffusion restriction, low apparent diffusion coefficient values, incomplete suppression on fluid-attenuated inversion recovery images, no contrast enhancement, and no hydrocephalus or mass effect, radiologically consistent with an epidermoid cyst. The presentation was considered most consistent with probable situational reflex syncope, and the lesion likely incidental, although a causal contribution could not be definitively excluded. Surgical resection was recommended; its rationale was not documented. The patient declined surgery and left against medical advice; therefore, histopathological confirmation was unavailable. At 6-month telephone follow-up, he reported no recurrent syncope or new neurological symptoms but had not undergone neurosurgical, imaging, or cardiac follow-up.
CONCLUSIONS
Hair-grooming syncope should be considered when syncope is temporally related to grooming and the neurological examination is normal. Routine neuroimaging has a low yield in uncomplicated syncope; when an intracranial lesion is detected, its causal relevance should be judged by anatomical and clinical plausibility rather than its mere presence.

Keywords: Diffusion Magnetic Resonance Imaging; Syncope, Vasovagal; Epidermoid Cyst; Incidental Findings; Emergency Service, Hospital