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Takehiko Yanagihara, MD; Donald W. Klass, MD; David G. Piepgras, MD; O. Wayne Houser, MD

Arch Neurol. 1989;46(8):858-861.

Abstract
• Loss of consciousness is rare in the absence of transient or persistent insult to the diencephalon or mesencephalon. We found three patients with severe atherosclerotic stenosis or occlusion of both internal carotid arteries who experienced brief loss of consciousness. Common characteristics were the absence of clinical or electroencephalographic seizure activities, significant cardiovascular disease, or a history suggestive of vasovagal syncope. Angiographically, the patients had widely patent vertebrobasilar circulation and collaterals from vertebrobasilar to carotid circulation. Episodic loss of consciousness disappeared after carotid endarterectomy. We concluded that bilateral hemispheric ischemia caused brief loss of consciousness, but selective focal ischemia in the subcortical structures superimposed on widespread bihemispheric ischemia may have been responsible. Since loss of consciousness is rare in carotid occlusive diseases, systemic and vertebrobasilar causes must be carefully ruled out in each instance.

Author Affiliations
From the Department of Neurology (Dr Yanagihara), the Section of Electroencephalography (Dr Klass), and the Departments of Neurologic Surgery (Dr Piepgras) and Diagnostic Radiology (Dr Houser), Mayo Clinic and Mayo Foundation, Rochester, Minn.

Footnotes
Accepted for publication March 17, 1989.

Reprint requests to Department of Neurology, Mayo Clinic, Rochester, MN 55905 (Dr Yanagihara).

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