This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
In “Clinical Reasoning: A Young Man With Daily Episodes of Altered Awareness,” Villamar et al. described the differential diagnosis, evaluation, and management of a patient with episodic alteration of awareness who was ultimately diagnosed with stretch syncope. Shubhakaran commented that the distinction between syncope and seizure can be challenging, but the number of movements during events and combined use of video EEG and a tilt table may be helpful. Shubhakaran also suggest that more people may extend their neck while drinking water today than in the past and that this could increase the risk of syncope and cervical radiculopathy. Villamar et al. respond that although the pathophysiology of stretch syncope is not fully elucidated, it only occurs in individuals with a predisposition for inadequate blood pressure regulation (e.g., in the setting of a small fiber cholinergic neuropathy and impaired vasodilation), rather than any person who frequently hyperextends their neck, and it is not associated with cervical radiculopathy/myelopathy.
In “Clinical Reasoning: A Young Man With Daily Episodes of Altered Awareness,” Villamar et al. described the differential diagnosis, evaluation, and management of a patient with episodic alteration of awareness who was ultimately diagnosed with stretch syncope. Shubhakaran commented that the distinction between syncope and seizure can be challenging, but the number of movements during events and combined use of video EEG and a tilt table may be helpful. Shubhakaran also suggest that more people may extend their neck while drinking water today than in the past and that this could increase the risk of syncope and cervical radiculopathy. Villamar et al. respond that although the pathophysiology of stretch syncope is not fully elucidated, it only occurs in individuals with a predisposition for inadequate blood pressure regulation (e.g., in the setting of a small fiber cholinergic neuropathy and impaired vasodilation), rather than any person who frequently hyperextends their neck, and it is not associated with cervical radiculopathy/myelopathy.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2022 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Differences in Age-related Retinal and Cortical Atrophy Rates in Multiple Sclerosis
Prof. Massimo Filippi and Dr. Paolo Preziosa