The carotid sinus is a small bundle of nerve endings situated next to the carotid. Carotid sinus hypersensitivity and syncope mayo clinic. The cavernous sinus syndrome, can associate multiple symptoms. The hypersensitive carotid sinus syndrome css is defined as syncope or presyncope resulting from an extreme reflex response to the carotid sinus stimulation. Carotid sinus hypersensitivity in asymptomatic older persons. By observing and recording how the blood pressure of a patient and other symptoms change during stimulation, doctors can determine the seriousness of the condition. Get a printable copy pdf file of the complete article 246k, or click on a page image below to browse page by page. Carotid sinus syndrome is an important but frequently overlooked cause of syncope and presyncope in older persons. Any information contained in this pdf file is automatically generated from digital material. Presented at the tenth annual meeting of the southern association for vascular surgery, cerromar beach, puerto rico, jan.
Carotid sinus hypersensitivity csh consists of the observation that stimulation of the carotid artery baroreceptors in the neck results in a greater than expected fall in heart rate and drop in blood pressure. Broad categories of diseases involving the cavernous sinus can cause the socalled cavernous sinus syndrome. Carotid sinus syndrome is a cause of syncope and falls in the elderly that is frequently overlooked because of different reasons, nevertheless it might be present in up to 40% of subjects older. These are the cases handled, whether cardioin hibitory type or even if mixed, with implantation of pace maker pm.
Carotid sinus syndrome is common in dementia with lewy. Specifically, although the finding of carotid sinus hypersensitivity may indeed indicate an exaggerated vagal tone that causes syncope, it may also be a chance association in a patient with syncope due to another cause. The carotid sinus is a widened portion of the carotid artery where. Intraoperative management facilitated by temporary transvenous demand pacing you will receive an email whenever this. Carotid sinus syndrome is a rare but serious manifestation of head and neck malignancy. Pdf carotid sinus syndrome as a manifestation of head and neck cancer an interesting case where a patient with head and neck cancer. Carotid sinus syndrome css is a disease of the autonomic nervous. Carotid sinus syndrome information about hospitals and doctors. A frequently overlooked cause of syncope in the elderly.
The term induced carotid sinus syndrome refers to a clinical situation in which a patient has no clear history of accidental mechanical manipulation of the carotid sinuses and has a negative result from workup for syncope, except for a hypersensitive emedicine. Although carotid sinus syndrome css has been known since the 1930s. The aetiology is unknown and epidemiological data is limited. Carotid sinus syndrome after carotid artery surgery. Carotid sinus syndrome was defined as demonstrated csh associated with a. Carotid sinus syndrome css is an illrecognized condition leading to dizziness, syncope, and falls in senior people. Background carotid sinus hypersensitivity is the most commonly reported cause of falls and syncope in older persons. Rarely, head and neck tumors can cause carotid sinus syndrome. A carotid cavernous sinus fistula is an abnormal connection that forms between a carotid artery in your neck and the network of veins at the back of your eye. Carotid sinus hypersensitivity and carotid sinus syndrome uptodate. This classically presents as a patient who has fainted actually a presyncope on several. Carotid sinus stimulation definition of carotid sinus. It is caused by dysregulation of heart rhythm andor blood pressure, probably following aging and subsequent instability of carotid sinus baroreceptors. Clinical experience of a new rate drop response algorithm.
Carotid sinus syndrome definition of carotid sinus. The cardioinhibitory carotid sinus syndrome annals. Get a printable copy pdf file of the complete article 279k, or. Although carotid sinus syndrome css has been known since the 1930s and cardiac pacing has been a therapeutic option since the early 1970s, the diagnostic value of carotid sinus massage is still controversial and its usage in clinical practice varies widely among physicians and centres. The patient with a hypersensitive carotid sinus reflex and syncope may pose special challenges in evaluation and treatment. Clinical experience of a new rate drop response algorithm in the treatment of vasovagal and carotid sinus syncope. Cavernous sinus syndrome cavernous sinus structure. Carotid sinus syncope, sometimes called the tightcollar syndrome, also causes brief unconsciousness from impaired blood flow to the brain. Carotid sinus hypersensitivity 5minute clinical consult. Carotid sinus syndrome is a cause of syncope and falls in the elderly that. When affected by diseases they give rise to a cs syndrome including congenital epithelial cysts, acquired infections, inflammatory disorders, vascular lesions and neoplasms 14. The syndrome is diagnosed in persons with otherwise unexplained.
Carotid sinus hypersensitivity or carotid sinus syndrome. Carotid sinus massage reproduced spontaneous symptoms in 164. Recent guidelines recommend 5 to 10 seconds of carotid sinus massage in supine and upright positions with beattobeat monitoring. Clinical experience of a new rate drop response algorithm in the treatment. Pacemaker implantation for carotid sinus hypersensitivity csh. Knowledge of the role of the carotid sinus reflex in regulating and controlling the endovascular blood pressure is due chiefly to the researches of hering. Symptoms of marked dizziness or syncope were reproduced by gentle compression over the carotid bifurcation, while ecg monitoring revealed bradycardia or. The presentation of this type of the syndrome was remarkable, since it is usually associated with primary or metastatic carcinoma in the neck region. Because treatment options are numerous and the incidence of carotid sinus. The day prior to admission she developed intermittent presyncopal episodes without clear inciting factors. Carotid sinus syndrome european society of cardiology. The term induced carotid sinus syndrome refers to a clinical situation in which a patient has no clear history of accidental mechanical manipulation of the carotid sinuses and has a negative result from workup for syncope, except for a hypersensitive response to carotid sinus massage, which can be attributed to the patients symptoms. Carotid sinus hypersensitivity or carotid sinus syndrome is more found in the elderly population. There appears to be a high prevalence of carotid sinus hypersensitivity csh in patients with dementia with lewy bodies dlb but not in alzheimers disease.
Symptomatic bradycardia from carotid sinus syndrome kristin kipps, m. The concept that the cs wa s sinus or plexus was related to an issue of. Carotid sinus syndrome as the presenting symptom of. To compare the prevalence of csh in dlb and alzheimers disease, and to determine whether there is an association between csh induced. Recurrent syncope due to carotid sinus hypersensitivity and sick sinus syndrome. Carotid sinus syndrome as a manifestation of head and neck. The index to diseases and injuries is an alphabetical listing of medical terms, with each term mapped to one or more icd10 codes. Assessment of the vasodepressor reflex in carotid sinus syndrome is influenced by the method of execution of the carotid sinus massage and the coexistence of the cardioinhibitory reflex. Carotid sinus syndrome css is a common cause of syncope in older persons.
The czermakhering test is a vagal maneuver consisting of the application of external digital pressure to the carotid sinus. In carotid sinus hypersensitivity or carotid sinus syndrome, the carotid sinus artery becomes extremely sensitive to any type of stimulus and as a result starts affecting the heart rate, appropriate blood flow to the brain, and the blood pressure. Carotid sinus hypersensitivity csh becomes a disease when it becomes responsible of falls and syncope. Following acute vascular surgery of the carotid artery, she developed the vasodilatory type of the carotid sinus syndrome. The test is performed at the patients bedside by imposing moderate pressure with the fingers, repeatedly massaging the left or the right carotid arteries. Abstract of interest for years as a readily demonstrable etiologic factor in certain cases of syncopal or convulsive attacks, the cardioinhibitory carotid sinus syndrome has itself fallen under suspicion as a manifestation of myocardial disease. Pdf assessment of the vasodepressor reflex in carotid. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Benditt d et al the evaluation and treatment of syncope 2003. Carotid sinus syndrome css is a disease of the autonomic nervous system presenting with syncope, especially in older males who often have cardiovascular disease. This process is where this part of the artery is manually stimulated under controlled, highly monitored conditions. The carotid sinus can be oversensitive to manual stimulation, a condition known as carotid sinus hypersensitivity, carotid sinus syndrome or carotid sinus syncope, in which manual stimulation causes large changes in heart rate andor blood pressure. Carotid sinus hypersensitivity clinical presentation. Articles from british medical journal are provided here courtesy of bmj publishing group.
In this case the diction carotid sinus syndrome css is pre ferred. Carotid sinus reflex works rapidly in younger people but sometimes is much slower in older people, especially those with circulatory problems. Although a number of different types of the syndrome have been proposed by weiss and baker, it is not always easy to fit a patient into these categories. Symptomatic bradycardia from carotid sinus syndrome. However, to our knowledge, this is the first report of cystadenolymphoma presenting as recurrent syncopal. Carotid sinus syndrome can be diagnosed with carotid sinus massage. Best hospitals and doctors for carotid sinus syndrome treatment abroad. To compare the prevalence of csh in dlb and alzheimers disease, and to determine whether there is an. The cavernous sinus is a small but complex structure consisting of a venous plexus, the carotid artery, cranial nerves, and sympathetic fibers. Csh is a relatively common observation but only an infrequent cause of spontaneous symptoms.