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November 12, 1982

Facial Color and Syncope

JAMA. 1982;248(18):2238. doi:10.1001/jama.1982.03330180012012

To the Editor.—  In the recent article by Kapoor et al (1982;247:2687) that dealt with syncope, the authors correctly addressed the problems of evaluating the conditions of these patients. Mechanical activation procedures, eg, carotid sinus massage or compression, should not be used, since this may produce syncope that differs from the spontaneous spells.1 In our studies of patients with syncope, we have found that a thorough history, which includes interviewing witnesses with questions about the color of the patient's face at the time of loss of consciousness, is invaluable.2,3 To date, we have studied 42 patients whose loss of consciousness was characterized by a pale, white, or ashen face; hence, the paleface syndrome of loss of consciousness. This pale facial appearance is a peripheral manifestation of decreased blood flow to the face and head. Most episodes of the paleface syndrome occur during exertion in an upright position and can often