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Correspondence
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Volume 339:1857 December 17, 1998 Number 25
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Neurocardiogenic Syncope

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by Diehl, R. R.
To the Editor: The Image in Clinical Medicine by Diehl and Linden (July 30 issue)1 shows the cardiovascular changes associated with neurocardiogenic syncope. Unfortunately, the syncope progressed to a generalized seizure. I question the ethics of observing and recording this episode without intervening. Allowing the patient's hypoxia to worsen concerns me because of the possibility of irreversible damage to the myocardium or brain. Such a seizure may induce a kindling process, which lowers the threshold for future seizures.2,3 Instead of allowing the syncope to progress to more severe cerebral hypoxia and seizure, the observing physician could have decreased brain hypoxia . . . [Full Text of this Article]

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