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Editor's Correspondence
December 14, 2009

Carotid Disease and Syncope

Arch Intern Med. 2009;169(22):2162-2166. doi:10.1001/archinternmed.2009.447

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.

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