Recurrent syncope due to carotid sinus hypersensitivity in cerebral atherosclerosis

A 62-year-old female with a history of stroke due to cerebral arteriosclerosis suffered from recurrent fainting (<10s) provoked by rapid head movements up to four times per month for at least two years. There was no evidence of new strokes in repeated MRI and no high-grade vertebral artery stenosis on catheter angiography. Electroencephalography and cardiovascular workup were normal. Because fainting was head-position triggered, carotid massage was performed, demonstrating transient sinus arrest and carotid sinus syndrome (CSS) was diagnosed. After pacemaker implantation, episodes disappeared. Based on this case we discuss the diagnostic approach and also potential pitfalls and limitations of CSS