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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.
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Author disclosures are available upon request (journal{at}neurology.org).
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