Monthly Case

A 57-year-old male patient reports loss of consciousness and subsequent falls when he laughs. One of the falls resulted in nasal bone fracture. These events have occurred for more than 25 years. The more intense he laughs, the more likely he looses consciousness. In the last 12 months, this has happened five times. Family members report that loss of consciousness lasts almost 1 minute, motor signs are lacking, reorientation occurs rapidly.

This information suggests that the events are consistent with syncopes. Accordingly, 24 h-video-EEG-monitoring and head MRI were normal. During echocardiography, manual pressure to the left carotid sinus was accompanied by relevant bradycardia, the patient reported severe dizziness.

In summary, this patient suffers from hypersensitive carotid sinus (“carotid sinus syndrome”). Short-term increased blood pressure – while laughing – results in bradycardia and subsequent syncope. To protect the patient from further syncopes and potential injuries, he promptly will undergo implantation of a cardiac pacemaker.

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