CAROTID-SINUS SYNCOPE - THE MOST FREQUENT NEURALLY-MEDIATED SYNCOPE IN THE ELDERLY

The present work reviews current literature and the authors' experienc e of carotid sinus syndrome (CSS), which is considered to be the most common cause of neurally mediated acute disorders of consciousness in the elderly. Although no definitive consensus about its nosology has y et been reached, most groups agree that three features fulfill the dia gnosis: anamnestic presence of syncope or its minor equivalents, and t heir reproduction by carotid sinus massage associated with defined val ues of cardioinhibition or vasodepression or both. The technique for p erforming carotid sinus massage used by the authors is described; this manoeuvre seems very safe and reproducible as long as simple rules ar e followed, and it allow the classification of CSS types. The treatmen t of CSS is varied, according to several factors. No pharmacological t herapy has yet been demonstrated to be effective. While severe cardioi nhibitory forms require an appropriate pacing, vasodepressive ones and types with only minor symptoms show a more favourable natural history . Pacing is advised in mixed CSS with either frequent and invalidating relapses, or 'high risk' attacks (severe, abrupt, with major traumas, etc.). Finally, the protocol for choosing the adequate mode of pacing is illustrated. In most cases VVI is sufficient, but the decision req uires a careful individual examination.