Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009
Mendu and colleagues1 report on the yield of testing among older patients with syncope. They report no cerebrovascular cause of syncope, even though many of their patients had a history of stroke (16%), mental status changes (4%), symptoms suggestive of stroke (1%), and neurologic deficits on examination (6%). This makes sense because syncope, defined as the sudden, transient loss of consciousness with spontaneous recovery, cannot be caused by a cerebrovascular event (unless there are tremendous associated neurologic findings). Carotid disease is particularly implausible as a cause of syncope, yet 13% of patients underwent carotid ultrasound studies.
Finucane TE. Carotid Disease and Syncope. Arch Intern Med. 2009;169(22):2162-2166. doi:10.1001/archinternmed.2009.447