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November 1992

Cardiovascular Investigation in Elderly Patients With Transient Unresponsiveness

Author Affiliations

Department of Neurology University of Genova Via de Toni 5 16132 Genova, Italy

Arch Neurol. 1992;49(11):1112. doi:10.1001/archneur.1992.00530350022012

To the Editor.  —Haimovic and Beresford1 described five cases of transient unresponsiveness in elderly subjects. They claimed that those episodes "could not be explained by metabolic, structural, convulsive, or psychiatric disease," and that the speculation about the causes included "diffuse cerebral ischemia, atypical generalized seizures, and a form of sleep disorder."1 Electroencephalographic findings are against psychiatric disorders, epileptic seizures, as well as prolonged postictal encephalopathies.2 Furthermore, there is no evidence, based on history or clinical findings, to support the sleep disorder hypothesis. Some of the patients described1 had risk factors for cardiovascular disease (patients 2, 4, and 5), one patient died of sudden death (patient 4), and one patient was admitted because of the presence of congestive heart failure (patient 5). Thus, diffuse cerebral ischemia seems to be a likely cause of the episodes reported, at least in some cases. It is well known that cardiac

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