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Mechanism of Syncope Due to Unilateral Compression of Carotid Bifurcation

Mechanism of Syncope Due to Unilateral Compression of Carotid Bifurcation Abstract During the past six years we have had an opportunity to study many patients with partial or complete internal carotid occlusion in the neck.* It has been found that digital compression of the opposite carotid bifurcation results in syncope in the greatest majority of these patients (Table 1). Particularly important are the patients with partial occlusion of the internal carotid artery at the bifurcation who develop syncope on digital compression of the opposite carotid bifurcation (Table 2). The mechanical obstruction of the vessel results in an arrest or a decrease in carotid blood flow in the brain on the good side with consequent ischemia and syncope. This clinical response simulates the syncope described in the past as due to stimulation of a "hypersensitive carotid sinus" with a "cerebral type" of reaction.† Although our patients presented advanced cerebrovascular disease, it is quite likely that, even with less serious cerebrovascular atherosclerosis, patients References 1. References 2 to 7. 2. References 1 and 8. 3. References 4 and 5. 4. Ferris, E. B., Jr.; Capp, R. B., and Weiss, S.: Carotid Sinus Syncope and Its Bearing in the Mechanism of the Unconscious State and Convulsions , Medicine 14:377-456, 1935.Crossref 5. Gurdjian, E. S., and Webster, J. E.: Spontaneous Thrombosis of the Carotid Arteries in the Neck , Tr. Am. Neurol. A. 74:50-54, 1949. 6. Gurdjian, E. S., and Webster, J. E.: Stroke Resulting from Internal Carotid Artery Thrombosis in the Neck , J. A. M. A. 151:541-545, 1953. 7. Hering, H. E.: Die Karotissinusreflexe auf Herz und Gefässe vom normal-physiologischen. pathologisch-physiologischen und klinischen Standpunkt , Dresden, T. Steinkopff, 1927. 8. Heymans, C.: Pressoreceptive Mechanism for the Regulation of Heart Rate, Vasomotor Tone, Blood Pressure and Blood Supply , New England J. Med. 219:147-154, 1938.Crossref 9. Sugar, H. S.; Webster, J. E., and Gurdjian, E. S.: Ophthalmologic Findings in Spontaneous Thrombosis of the Carotid Arteries , Arch. Ophth. 44:823-832, 1950.Crossref 10. Webster, J. E.; Dolgoff, S., and Gurdjian, E. S.: Spontaneous Thrombosis of the Carotid Arteries in the Neck: Report of 4 Cases , Arch. Neurol. & Psychiat. 63:942-953, 1950. 11. Weiss, S., and Baker, J. P.: The Carotid Sinus Reflex in Health and Disease , Medicine 12:297-354, 1933. 12. Askey, J. M.: Hemiplegia Following Carotid Sinus Stimulation , Am. Heart J. 31:131-137, 1946. 13. Matas, R.: Testing the Efficiency of the Collateral Circulation as a Preliminary to the Occlusion of the Great Surgical Arteries , J. A. M. A. 63:1441-1447, 1914. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Neurology & Psychiatry American Medical Association

Mechanism of Syncope Due to Unilateral Compression of Carotid Bifurcation

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Publisher
American Medical Association
Copyright
Copyright © 1955 American Medical Association. All Rights Reserved.
ISSN
0096-6886
DOI
10.1001/archneurpsyc.1955.02330170090015
Publisher site
See Article on Publisher Site

Abstract

Abstract During the past six years we have had an opportunity to study many patients with partial or complete internal carotid occlusion in the neck.* It has been found that digital compression of the opposite carotid bifurcation results in syncope in the greatest majority of these patients (Table 1). Particularly important are the patients with partial occlusion of the internal carotid artery at the bifurcation who develop syncope on digital compression of the opposite carotid bifurcation (Table 2). The mechanical obstruction of the vessel results in an arrest or a decrease in carotid blood flow in the brain on the good side with consequent ischemia and syncope. This clinical response simulates the syncope described in the past as due to stimulation of a "hypersensitive carotid sinus" with a "cerebral type" of reaction.† Although our patients presented advanced cerebrovascular disease, it is quite likely that, even with less serious cerebrovascular atherosclerosis, patients References 1. References 2 to 7. 2. References 1 and 8. 3. References 4 and 5. 4. Ferris, E. B., Jr.; Capp, R. B., and Weiss, S.: Carotid Sinus Syncope and Its Bearing in the Mechanism of the Unconscious State and Convulsions , Medicine 14:377-456, 1935.Crossref 5. Gurdjian, E. S., and Webster, J. E.: Spontaneous Thrombosis of the Carotid Arteries in the Neck , Tr. Am. Neurol. A. 74:50-54, 1949. 6. Gurdjian, E. S., and Webster, J. E.: Stroke Resulting from Internal Carotid Artery Thrombosis in the Neck , J. A. M. A. 151:541-545, 1953. 7. Hering, H. E.: Die Karotissinusreflexe auf Herz und Gefässe vom normal-physiologischen. pathologisch-physiologischen und klinischen Standpunkt , Dresden, T. Steinkopff, 1927. 8. Heymans, C.: Pressoreceptive Mechanism for the Regulation of Heart Rate, Vasomotor Tone, Blood Pressure and Blood Supply , New England J. Med. 219:147-154, 1938.Crossref 9. Sugar, H. S.; Webster, J. E., and Gurdjian, E. S.: Ophthalmologic Findings in Spontaneous Thrombosis of the Carotid Arteries , Arch. Ophth. 44:823-832, 1950.Crossref 10. Webster, J. E.; Dolgoff, S., and Gurdjian, E. S.: Spontaneous Thrombosis of the Carotid Arteries in the Neck: Report of 4 Cases , Arch. Neurol. & Psychiat. 63:942-953, 1950. 11. Weiss, S., and Baker, J. P.: The Carotid Sinus Reflex in Health and Disease , Medicine 12:297-354, 1933. 12. Askey, J. M.: Hemiplegia Following Carotid Sinus Stimulation , Am. Heart J. 31:131-137, 1946. 13. Matas, R.: Testing the Efficiency of the Collateral Circulation as a Preliminary to the Occlusion of the Great Surgical Arteries , J. A. M. A. 63:1441-1447, 1914.

Journal

A.M.A. Archives of Neurology & PsychiatryAmerican Medical Association

Published: Nov 1, 1955

References