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Jack N. Alpert, MD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The article by Dr Louis Caplan¹ raises both interesting and disturbing questions. I suspect that this concept is a return to the old, discredited diagnosis, cerebrovascular insufficiency. Undoubtedly, many of these patients given this diagnosis may have had transient ischemic attacks. In elderly patients, however, other diagnoses are quite common; yet the history is obscured by vague recollections, poor vocabulary, and inadequate self-expression. Persistent prompting is usually required.

Recently, I have seen 2 elderly patients (>75 years) who exemplify this problem. The first reported nonspecific dizziness only when walking. A Dix-Hallpike maneuver disclosed overt benign paroxysmal positional vertigo. She had denied vertigo when lying down or turning in bed. A second patient reported dizzy spells lasting 1 to 2 minutes, occurring in any position, on several occasions during the previous 2 months. Neurology consultation was requested after magnetic resonance imaging, magnetic resonance angiography, and cardiology assessment . . . [Full Text of this Article]

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