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OBJECTIVE. Reflex anoxic cerebral crises are due to depression of nerve function caused by a vagotonic state or vagal hypersensitivity. In this paper we propose to review the physiopathology, clinical features and diagnostic procedures of these crises. DEVELOPMENT. There are three types of reflex anoxic cerebral crises: asphyxiating anoxic crises, ischemic anoxic crises and asphyxiating-ischemic anoxic crises. They are caused by sudden activation of the so-called syncopal reflex. They are characterized by diverse clinical manifestations and may often be mistaken for epileptic crises. They are related to various precipitating factors such as a blow, often to the head, an emotional stimulus or something which upsets or molests, hyperthermia, abdominal pain, headache, physical exertion, prolonged standing-up, exposure to heat, the sight of blood, feeling of fear and other factors.
CONCLUSIONS. Important elements for the diagnosis of these crises are the presence of a family history of vagal crises, the presence of precipitating factors, brief duration of the crises (seconds) in most patients, and clinical signs of facial or perioral pallor or cyanosis. The test involving pressure on the eyeball and the tilting table are useful for diagnosis. However, they should be used sensibly
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