Incidence of complications after carotid sinus massage in older patients with syncope.
OBJECTIVE
To review the incidence of neurological complications occurring after carotid sinus massage performed for diagnostic purposes.


METHODS
Case review and comparison with previously published work.


METHODS
Syncope Clinic, Royal Victoria Infirmary, Newcastle-upon-Tyne, and Chelsea and Westminster Hospital, London.


METHODS
Patients undergoing investigation of dizziness, syncope, or unexplained falls.


METHODS
Carotid sinus massage performed for 5 seconds in both supine and erect postures, both before and after atropine. Contraindications to carotid sinus massage were the presence of carotid bruits, recent myocardial or cerebral ischemia, or previous ventricular tachyarrhythmias.


RESULTS
Two cases of neurological complications were reported from a total of 500 patients (2000 massage episodes) investigated in one center, giving an incidence of 0.1%. Combining this data with another center performing investigations in a similar fashion, seven neurological complications arose from a total of 5000 massage episodes, an incidence of 0.14%. Reported complications were pyramidal signs in five cases and visual field defects in two. Pyramidal weakness persisted in one case with a pre-existing stroke on the same side, and a visual field loss was permanent in one.


CONCLUSIONS
Neurological complications following carotid sinus massage for diagnosis of the carotid sinus syndrome are uncommon and usually transient. Contraindications to carotid sinus massage should be respected and the standardized technique used.
Munro
N C
NC
Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, London, UK.
McIntosh
S
S
Lawson
J
J
Morley
C A
CA
Sutton
R
R
Kenny
R A
RA
D000368:Aged; D000369:Aged, 80 and over; D001285:Atropine; D002346:Carotid Sinus; D000075202:Contraindications; D006801:Humans; D015994:Incidence; D008297:Male; D008405:Massage / Q000009:adverse effects*; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology*; D016683:Supine Position; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors
D001285:Atropine