We present an unusual case of CSH resulting from malignancy, representing a diagnostic and therapeutic challenge. [nzma.org.nz]

Nasopharyngeal carcinoma can present with different neurological signs and findings. In this paper, we report a patient presenting with Horner syndrome and syncopal episodes who was finally diagnosed with nasopharyngeal carcinoma. [ncbi.nlm.nih.gov]

CSS has three clinical types, the cardioinhibitory, vasodepressor and mixed type.1-3) The patient in our present report showed 6 seconds of sinus pause, and so this present case is the cardioinhibitory type. [synapse.koreamed.org]

The purpose of this book is to present a focused approach to the pathophysiology, diagnosis, and management of the most common autonomic disorders that may present to the clinical neurologist. Autonomic Neurology is divided into 3 sections. [books.google.com]

• Falling

  Syncope was defined as a rapid onset of transient and self-limited loss of consciousness usually associated with falling, with complete and spontaneous recovery.9 A fall was defined as coming to rest on the ground or any other lower level without loss [jamanetwork.com]

  Non accidental falls These patients experience recurrent episodes of non accidental and unexplained falls which occur when there is transinet brain hypoperfusion and loss of consciousness. [medicaljoyworks.com]

  CSS is common in older patients, and even for those patients with no history of syncope or falls. [synapse.koreamed.org]

  ROLE OF CSS IN RECURRENT SYNCOPE AND FALLS This retrospective study suggests that CSS is responsible for recurrent falls and syncope in 20.8% of patients referred to a medical outpatient clinic. [pmj.bmj.com]

  Implication for diagnosis of syncope and falls. Arch Intern Med 2006 166 515–520. [ PubMed ] [ Google Scholar ] [ncbi.nlm.nih.gov]

• Pallor

  Unlike the ordinary faint, this syncope is not preceded by pallor, nausea, and sweating. [britannica.com]

  […] ex Conditions.. e73 6 (...) is characterized by diaphoresis, warmth, nausea, and pallor; 3) is associated with vasodepressor hypotension and/or inappropriate bradycardia; and 4) is often followed by fatigue. [tripdatabase.com]

  Metastatic cancer Commonly Associated Conditions Sick sinus syndrome Atrioventricular block Coronary artery disease Diagnosis History Syncope Unexplained falls Abnormal gait and balance Absence of postictal symptoms Physical Exam Bradycardia Hypotension Pallor [tipsdiscover.com]

  […] syncope is still unclear, it is most likely due to a combination of several factors: changes in the autonomic nervous system, hormonal changes, coexistence of multiple pathologies and polypharmacy. 3 Vasovagal syncope is classically preceded by prodromes (pallor [scielo.mec.pt]

  Symptoms are often vague; typical features of NMS, such as pallor and sweatiness, are absent. The eyes are usually open in epileptic seizures and syncope but are usually closed in functional transient loss of consciousness. [patient.info]

• Disability

  In the next article, we show the case of a sexagenarian female patient with a disabling syncope and a 7 cm carotid body paraganglioma, which did not allow her the minimum movement of lateral dorsiflexion or extension of the neck. [ncbi.nlm.nih.gov]

  Please enable JS and disable any ad blocker [lequotidiendumedecin.fr]

  For example fractured femurs cost about £165 million a year and 20% of orthopaedic beds are occupied by these patients11 with a mortality of 30%–40% and a substantial disability among survivors.12 It is therefore essential to identify causes of recurrent [pmj.bmj.com]

  Syncope may result in significant morbidity and disability due to falls or accidents that occur as a result. [6] In the United States alone, an estimated $2 billion annually is spent on patients hospitalized with syncope. [emedicine.medscape.com]

• Yawning

  Frequently, patients developing NMS develop symptoms such as yawning and hyperventilation. [ww2.mc.vanderbilt.edu]

  The prodrome, characterized by diaphoresis, epigastric discomfort, extreme fatigue, weakness, yawning, nausea, dizziness, and vertigo, results from increased parasympathetic tone and may last seconds to several minutes. [aafp.org]

• Abdominal Pain

  Synonym(s): intermittent claudication Charcot triad - (1) in multiple (disseminated) sclerosis, the three symptoms: nystagmus, tremor, and scanning speech; - (2) combination of jaundice, fever, and upper abdominal pain that occurs as a result of cholangitis [medical-dictionary.thefreedictionary.com]

  Vasovagal syncope Emotional triggers and typical prodromes, in the absence of cardiopathy, with a normal ECG, and no family history of sudden death Situational syncope When clearly associated with coughing, urination, abdominal pain, in the absence of [revespcardiol.org]

  Symptoms associated with POTS include those that occur with standing (eg, lightheadedness, palpitations); those not associated with particular postures (eg, bloating, nausea, diarrhea, abdominal pain); and those that are systemic (eg, fatigue, sleep disturbance [ahajournals.org]

• Dyspepsia

  Somatization Disorder Thrombotic Thrombocytopenic Purpura Trigger Finger (Digital Stenosing Tenosynovitis) Trochanteric Bursitis NEW ALGORITHMS INCLUDE Amenorrhea, Primary Amenorrhea, Secondary Back Pain, Acute Bleeding, Gastrointestinal Breast Mass Dyspepsia [books.google.com]

• Orthostatic Hypotension

  hypotension ( G90.3 ) orthostatic hypotension ( I95.1 ) postprocedural shock ( T81.1- ) psychogenic syncope ( F48.8 ) shock NOS ( R57.9 ) shock complicating or following abortion or ectopic or molar pregnancy ( O00 - O07, O08.3 ) shock complicating or [icd10data.com]

  At baseline, the examination ended with a search for orthostatic hypotension. [academic.oup.com]

  He had no orthostatic hypotension. He experienced another unprovoked syncopal episode in hospital associated with bradycardia (and preceded by 6 second pause) and hypotension. He had a positive controlled carotid sinus massage (CSM) test. [nzma.org.nz]

  Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46(5):1470. doi: https://doi.org/10.1212/ WNL.46.5.1470. 18. [publicacoes.cardiol.br]

  Initial Orthostatic Hypotension is a more rare, but often missed cause of dizziness and syncope in young asthenic subjects and can be tested only by an active standing test with continuous blood pressure monitoring. [secardiologia.es]

• Heart Disease

  disease was greater than that observed among individuals who did not have structural heart disease (p<0.05) (Table 2). [scielo.br]

  The cause of death was classified into ischaemic heart disease, cerebrovascular disease, other circulatory diseases (including hypertensive heart disease, valvular heart disease, cardiac arrhythmias, ill-defined heart disease) and other causes (non-cardiovascular [bmjopen.bmj.com]

  The diagnostic yield of EPS is significantly greater in patients with heart disease; it is only rarely indicated in patients with clinically normal hearts and normal ECGs. [aafp.org]

  The workup of unexplained syncope depends on the presence or absence of heart disease: electrophysiologic study if the patient has heart disease, tilt-table testing in those without heart disease, and prolonged rhythm monitoring in both cases if syncope [mdedge.com]

• Palpitations

  Palpitations do not necessarily imply that syncope is due to an arrhythmia Thus, carotid massage is indicated in cases of unexplained syncope regardless of circumstantial triggers. [mdedge.com]

  It is not recommended in patients without heart disease, normal ECG, and no palpitations associated with syncope. [clevelandclinicmeded.com]

  […] day) Baseline Carotid sinus massage S/D BP (mmHg) HR (bpm) ECG (ms) S/D BP (mmHg) HR (bpm) Event/symptom PR QRS QTc 1 F/73 65 None None 143/74 66 132 78 396 132/76 46 None 2 F/82 76 None None 182/95 63 150 94 411 180/88 33 None 3 F/85 60 Hypertension palpitations [academic.oup.com]

  Syncope associated with exertion or palpitations suggests cardiac causes. Positional syncope may indicate orthostatic hypotension. [aafp.org]

  Sympathomimetics (ephedrine has been tried with success but has significant side effects, e.g., palpitations, tremors.) 2. Fludrocortisone with its mineralocorticoid effect also has been tried with limited success. 3. [encyclopedia.lubopitko-bg.com]

• Vascular Disease

  In people with carotid sinus hypersensitivity (exceptional responsiveness of the carotid sinuses in various types of vascular disease), external pressure on the carotid artery may cause slowing of the heart rate, a fall in blood pressure, and cardiac [abcradiology.blogspot.com]

  CONCLUSION Carotid artery ultrasounds should not be used to evaluate the cause of syncope in an effort to find incident symptomatic carotid vascular disease. [journalofhospitalmedicine.com]

  Gurdjian et al16 suggested that cerebral syncopal episodes without bradycardia or hypotension may be due to cerebral ischemia caused by occlusive vascular disease. [ajnr.org]

  Sixty of these patients had a diagnosis consistent with or predisposing to atherosclerotic vascular disease, including HTN, CAD, cerebrovascular disease, or an abdominal aortic aneurysm. CSM. [eplabdigest.com]

  congestive cardiac failure, peripheral vascular disease, any cardiovascular diagnosis, diabetes, hyperlipidemia, and cerebrovascular disease; and use of psychotropic medications, cardioactive medications, and antihypertensives (as a composite and individually [jamanetwork.com]

• Blurred Vision

  Syncope can either occur suddenly without any warning symptoms or can be preceded by sweating, nausea, blurred vision, pale skin and lightheadedness. + What Causes Syncope? + How Is Syncope Diagnosed and Treated? + + + + + + + + [biotronik.com]

  This includes a history of seizure activity, prolonged loss of consciousness, disturbance in vision (e.g., diplopia), headache and postictal symptoms; or focal neurologic signs or bruit upon physical examination. [aafp.org]

  As defined by the Heart Rhythm Society, POTS is a clinical syndrome characterized by frequent symptoms that occur with standing (ie, lightheadedness, palpitations, tremor, blurred vision, weakness, fatigue), an increase in heart rate of greater than 30 [clevelandclinicmeded.com]

• Diplopia

  Concurrent neurologic symptoms including vertigo, ataxia, or sensory disturbance often will be found. 7 Headache, vertigo, dysarthria, and diplopia also are suggestive of syncope resulting from neurologic causes. [aafp.org]

  Other important features of the physical examination include neurologic findings such as diplopia, dysarthria, nystagmus, ataxia and pupillary asymmetry, as well as cardiac findings such as carotid bruit, jugular venous distension, rales, a systolic murmur [ww2.mc.vanderbilt.edu]

  Prior vertigo, weakness, diaphoresis, epigastric discomfort, nausea, blurred or faded vision, pallor, or paresthesias Red flag symptoms - Exertional onset, chest pain, dyspnea, low back pain, palpitations, severe headache, focal neurologic deficits, diplopia [emedicine.medscape.com]

• Dizziness

  Forty-three participants (40% of those with CSH) had dizziness, presyncope, or syncope during CSM in conjunction with the hypersensitive response. Syncope was present in 18 (17%) and dizziness or presyncope in 25 (23%). [jamanetwork.com]

  The episodes were characterised by hypotension, sharp pain in the right neck, dizziness, and bradycardia. A temporary pacemaker failed to prevent the symptoms, but ephedrine and fludrocortisone produced substantial improvement. [ncbi.nlm.nih.gov]

  Recurrent dizziness This is also a result of brain hypopperfusion as described above. Recurrent dizziness This is also a result of brain hypopperfusion as described above. [medicaljoyworks.com]

  Carotid Sinus Hypersensitivity is a potentially dangerous response condition and is normally the cause of dizziness and more. Those with this condition often experience such dizzy spells - even resulting in unexplained falling over. [private-scuba.com]

  PARTICIPANTS: 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. [onlinelibrary.wiley.com]

• Drop Attacks

  Synonyms English : Attack, Drop Cardiogenic Syncope Cardiogenic Syncopes Carotid Sinus Syncope Carotid Sinus Syncopes Convulsive Syncope Convulsive Syncopes Deglutitional Syncope Deglutitional Syncopes Drop Attack Drop Attacks Effort Syncope Effort Syncopes [decs.bvs.br]

  These falls/attacks are called cryptogenic drop attacks. References:[5][12] The differential diagnoses listed here are not exhaustive. Treatment Complications References:[5] We list the most important complications. The selection is not exhaustive. [amboss.com]

  The asymptomatic groups of community‐dwelling older individuals were not necessarily healthy controls but were individuals without the symptoms of syncope, falls, or drop attacks. [ahajournals.org]

  CSH was also present in 35% of community-dwelling older individuals without any symptoms of syncope, falls or drop attacks (2). Etiology and Pathophysiology The exact mechanism of CSH remains unknown. [unboundmedicine.com]

• Vertigo

  Syncopal Vertigos, Syncopal [decs.bvs.br]

  […] as is possible Lay the diver down on any solid surface after surfacing Contact an emergency hotline for advice such as Divers Alert Network (DAN) Scuba Injuries | Overview | Drowning | Shock | Pulmonary Barotrauma | Salt Water Aspiration Syndrome | Vertigo [private-scuba.com]

  The vertigos gradually increased in frequency and intensity since they started one month prior her admission. [head-face-med.biomedcentral.com]

  Synonym(s): Charcot vertigo ; tussive syncope Charcot spine Charcot syndrome - a condition caused by ischemia of the muscles. [medical-dictionary.thefreedictionary.com]

  Two other patients described mild symptoms (dizziness or vertigo) but had no evidence of CSH. Only one patient had persistent symptoms associated with objectively demonstrable CSH. [jvascsurg.org]

• Abnormal Reflex

  R29.2 ICD-10-CM Diagnosis Code R29.2 Abnormal reflex 2016 2017 2018 2019 Billable/Specific Code Type 2 Excludes abnormal pupillary reflex ( H57.0 ) hyperactive gag reflex ( J39.2 ) vasovagal reaction or syncope ( R55 ) vasovagal R55 Syncope (near) (pre [icd10data.com]

  The abnormal reflex has been attributed to disturbance of baroreceptor function 4 and also to degeneration of the medulla. 5 CSS has overlap with VVS (Figure 2). [ncbi.nlm.nih.gov]

• Tremor

  Cancer Body Dysmorphic Disorder Borderline Personality Disorder Complementary and Alternative Medicine Corneal Abrasion Cubital Tunnel Syndrome De Quervain Tenosynovitis Dependent Personality Disorder Diabetic Polyneuropathy Epicondylitis Essential Tremor [books.google.com]

  Sympathomimetics (ephedrine has been tried with success but has significant side effects, e.g., palpitations, tremors.) 2. Fludrocortisone with its mineralocorticoid effect also has been tried with limited success. 3. [encyclopedia.lubopitko-bg.com]

  Synonym(s): intermittent claudication Charcot triad - (1) in multiple (disseminated) sclerosis, the three symptoms: nystagmus, tremor, and scanning speech; - (2) combination of jaundice, fever, and upper abdominal pain that occurs as a result of cholangitis [medical-dictionary.thefreedictionary.com]

  As defined by the Heart Rhythm Society, POTS is a clinical syndrome characterized by frequent symptoms that occur with standing (ie, lightheadedness, palpitations, tremor, blurred vision, weakness, fatigue), an increase in heart rate of greater than 30 [clevelandclinicmeded.com]

[…] trialled with limited success 4 Midodrine, fludrocortisone and sertraline were previously trialled by Sharma et al without any success. 6 This case highlights the importance of high clinical suspicion and thorough clinical examination in the diagnostic workup [nzma.org.nz]

The workup must exclude other causes of syncope as guided by the history and the physical examination. [encyclopedia.lubopitko-bg.com]

The workup of unexplained syncope depends on the presence or absence of heart disease: electrophysiologic study if the patient has heart disease, tilt-table testing in those without heart disease, and prolonged rhythm monitoring in both cases if syncope [mdedge.com]

He had extensive workup that included EEG (Electroencephalography), CT (computed Tomography) scan of head, echocardiography and cardiac stress test. All of these diagnostic studies performed were found to be unremarkable. [ispub.com]

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.medscape.com]

• Hypoglycemia

  CT/MRI Hypoglycemia Diabetes Clinical symptoms: symptoms of autonomic counterregulation (e.g., restlessness, sweating, pale skin) ↓ Blood glucose Craniocerebral injury Considerable head trauma (e.g., from falling) leading to traumatic brain injury Isolated [amboss.com]

  […] syncope, e.g., cardiac tachyarrhythmias and bradyarrhythmias, cardiac valvular disease and obstructive cardiomyopathy, cerebrovascular events, seizures, drug-induced, autonomic dysfunction, orthostasis/hypovolemia, cough, micturition, hypoxemia, and hypoglycemia [encyclopedia.lubopitko-bg.com]

  No blood biochemistry findings suggestive of anemia, dehydration, hypoglycemia, electrolyte abnormalities or thyroid disorder were observed. [bpsmedicine.biomedcentral.com]

  […] stenosis, atrial myxoma, thrombosis Difference between pulses or blood pressures between two arms Subclavian steal, aortic dissection Neurologic Parkinson’s disease Orthostatic hypotension Epilepsy Seizure Narcolepsy Narcolepsy Metabolic disorder Diabetes Hypoglycemia [aafp.org]

• Right Bundle Branch Block

  TABLE 5 Electrocardiographic Abnormalities Suggesting an Arrhythmic Syncope Bifascicular block (defined as left bundle branch block or right bundle branch block combined with left anterior or left posterior fascicular block) Other intraventricular conduction [aafp.org]

  Bifascicular block (right bundle branch block and either left anterior or left posterior fascicular block). [patient.info]

  ECG, electrocardiogram; LBBB, left bundle branch block; PHB, posterior hemiblock; RBBB, right bundle branch block; VT, ventricular tachycardia. [revespcardiol.org]

Combined drug treatment with a vasoconstrictor and plasma volume expander produced an improvement in symptoms but did not eliminate them. [ncbi.nlm.nih.gov]

AB - The patient with a hypersensitive carotid sinus reflex and syncope may pose special challenges in evaluation and treatment. [mayoclinic.pure.elsevier.com]

Patients on any form of treatment require regular follow-up to monitor the effects of treatment versus the adverse effects of intervention. Follow-up for patients who rarely have symptoms may be on an as-needed basis. Seifer C. [emedicine.medscape.com]

Cardiac pacing is the treatment of choice for cardioinhibitory carotid sinus syndrome (CSS), but syncope recurrence occurs in up to 20% of patients within 3 years. [tripdatabase.com]

[11] Patients with CSH showing a reduction in blood pressure after an carotid sinus stimulation have a worse prognosis than those with a pure cardio-inhibitory response or a lack of vasodepressor response.[11] [patient.info]

Prognosis Cardiac syncope has a poorer prognosis than other forms of syncope. The 1-year endpoint mortality has been shown to be as high as 18-33%. [emedicine.medscape.com]

Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (Short-Term Prognosis of Syncope) study. J Am Coll Cardiol. 2008 Jan 22. 51(3):276-83. [Medline]. Andrea U, Attilio DR, Franco G, et al. [medscape.com]

In every case the goal should be to determine the cause of syncope with sufficient confidence to provide patients and family members with a reliable assessment of prognosis, recurrence risk, and treatment options. [ncbi.nlm.nih.gov]

He declined to receive palliative radiation therapy to the cervical tumor or implantation of a temporary or permanent pacemaker because of their invasive nature and his poor prognosis. [bpsmedicine.biomedcentral.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Given the wide variety of etiologies and concern over potentially missing an important etiology, diagnostic testing can become elaborate, expensive, and frequently low yield. [journalofhospitalmedicine.com]

Syncope Summary Etiology Clinical features Diagnostics Differential diagnoses Treatment Complications [amboss.com]

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. [annals.org]

[…] merely to establish an etiological diagnosis ( Figure 1 ). [revportcardiol.org]

Special attention has also been paid to epidemiology and prevention, discussing all the issues concerned. [books.google.com]

[…] syncope and may be classified as: Spontaneous CSS: syncope after accidental mechanical manipulation (trigger) of the carotid sinuses (e.g., shaving, tight collars, or tumors) Induced CSS: syncope diagnosed by CSM, although no mechanical trigger is found Epidemiology [unboundmedicine.com]

Epidemiology Although baroreceptor function usually diminishes with age, some people experience hypersensitive carotid baroreflexes. CSH is rare before the age of 50. [patient.info]

SYNONYMS Carotid sinus syncope CSS EPIDEMIOLOGY & DEMOGRAPHICS • The incidence of carotid sinus hypersensitivity is 15% in the adult population. • The incidence increases with age. • Men are affected more often than women (2:1). • Carotid sinus syndrome [encyclopedia.lubopitko-bg.com]

Epidemiology Most often occurs in patients over age 60 years III. Category Carotid Sinus Hypersensitivity IV. Symptoms: Provocative maneuvers Head turning Tight shirt collar Shaving V. [tripdatabase.com]

Claydon e13448 First Published: 16 October 2017 Despite its high prevalence in the elderly, and reported association with devastating episodes of syncope and falls, the pathophysiology of carotid sinus hypersensitivity (CSH) remains unknown. [physreports.physiology.org]

Cerebral hemodynamic disturbances may play a crucial role in the pathophysiology of syncope with normal sinus rhythm and normotension. Moreover, direct depression of the CNS following carotid sinus distension is likely to be involved. [ncbi.nlm.nih.gov]

The purpose of this book is to present a focused approach to the pathophysiology, diagnosis, and management of the most common autonomic disorders that may present to the clinical neurologist. Autonomic Neurology is divided into 3 sections. [books.google.com]

Etiology and Pathophysiology The exact mechanism of CSH remains unknown. [unboundmedicine.com]

A temporary pacemaker failed to prevent the symptoms, but ephedrine and fludrocortisone produced substantial improvement. [ncbi.nlm.nih.gov]

Volume maintenance can control the vasodepressor form of CSH, preventing syncopal episodes by maintaining adequate central volume. [emedicine.medscape.com]

All the patients with NCS were treated conservatively (two patients were treated with fludrocortisone but the majority were advised on ways to prevent their symptoms; appendix ). [pmj.bmj.com]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]

Furthermore, tilt training was reported to prevent the recurrence of neurally mediated syncope [16]. [bpsmedicine.biomedcentral.com]