Amnesia for Loss of Consciousness in Carotid Sinus Syndrome
Open accessAbstract
Objectives The goal of this study was to compare the clinical characteristics of patients with carotid sinus syndrome who presented with falls with those who presented with syncope.Background Carotid sinus syndrome presents with both falls and syncope. The reasons for this differential presentation are unknown, but amnesia for loss of consciousness may be the underlying cause.Methods Two groups of 34 consecutive patients with carotid sinus syndrome as the sole cause of falls and syncope were recruited. Cognitive function and clinical characteristics were compared between the two groups.Results Syncopal subjects with carotid sinus syndrome were more likely to be older males (18 [53%] vs. 7 [21%] years; p = 0.006) with a longer duration of symptoms (27.9 vs. 13.3 months; p = 0.009) and more soft tissue injuries (19 [56%] vs. 9 [26%]; p = 0.03). Duration of asystole during carotid sinus massage was similar in both groups (5.1 vs. 5.4 s; p = 0.42), but witnessed amnesia for loss of consciousness was more frequent in fallers than those with syncope (21 [95%] vs. 4 [12%]; p < 0.001). Clinical characteristics and cognitive function were otherwise similar in both groups.Conclusions Patients with carotid sinus syndrome have similar rates of witnessed loss of consciousness during laboratory testing regardless of symptoms. However, those presenting with falls are far less likely to perceive any disturbance of consciousness than those with syncope, showing for the first time the manner in which such patients manifest symptoms. Cognitive impairment does not explain the amnesia for loss of consciousness seen in fallers with carotid sinus syndrome.
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If unwitnessed falls are not due to mechanical slips or trips, it is likely that the patient experienced a syncopal event and displayed lack of awareness for loss of consciousness.
“If unwitnessed falls are not due to mechanical slips or trips (i.e. are unexplained or nonaccidental), it is likely that the patient experienced a syncopal event and displayed lack of awareness for LOC”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [388]
The Discussion says that older patients with cardioinhibitory carotid sinus syndrome (CICSS) may fall after a microsyncopal event and not remember the loss of consciousness. The Participants section limits the study to people over 60 with recurrent unexplained falls or syncope and CICSS; it does not establish that unexplained unwitnessed falls generally are likely to involve syncope and amnesia. Page numbers were not provided in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPatients who present with unexplained falls may deny transient loss of consciousness despite orthostatic blood pressure measurements, carotid sinus massage, and tilt testing reproducing syncope, thus demonstrating amnesia for transient loss of consciousness.
“Not infrequently, patients who present with unexplained fallsalthough orthostatic BP measurements, CSM, and tilt testing reproduce syncope-may deny TLOC, thus demonstrating amnesia for TLOC. 388,389”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [388]
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References 15 · Cited by 102
Research works printed but not linked: 1
- Kenny RA, Richardson DA, Bexton RS, et al. Cardiac pacing reduces falls in carotid sinus hypersensitivity: the SAFE-PACE trial. J Am Coll Cardiol 2001;38:1491-6.
- Authors
- Parry, S. W., Steen, I. N., Baptist, M., & Kenny, R. A.
- Affiliations
- Royal Victoria Infirmary (GB)
- Newcastle University (GB)
- Corresponding author
- Parry, Steve W.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-06
- Volume
- 45
- Issue
- 11
- Pages
- 1840-1843
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2201612555
- Cited by
- 102
- References
- 15
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 4 · 2022: 8 · 2021: 1 · 2020: 1 · 2018: 6 · 2017: 7 · 2016: 8 · 2015: 10 · 2014: 8 · 2013: 7 · 2012: 2
- FWCI
- 3.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- British Heart Foundation
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- carotid sinus syndrome, syncope, falls, carotid sinus massage, asystole, cognitive impairment, presenting symptoms, soft tissue injury
- MeSH terms
- Accidental Falls, Amnesia, Carotid Sinus, Cognition, Female, Humans, Male, Syncope, Unconsciousness
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