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November 6, 1996

An 85-Year-Old Women With a History of Falls

Author Affiliations

Washington University School of Medicine St Louis, Mo

JAMA. 1996;276(17):1383. doi:10.1001/jama.1996.03540170027014

To the Editor.  —In regard to the evaluation of a patient who had fallen without fainting, Dr Lipsitz1 broadly recommends, "Carotid sinus massage should be performed on patients with unexplained falls, syncope, or drop attacks." He assures that "complications from carotid sinus massage... are very rare," citing Munro et al,2 who described a cohort in which 0.44% of 1600 patients had neurological complications, none trivial. Munro et al2 (and Lipsitz) arbitrarily spared from this risk those patients with "carotid bruits, recent myocardial or cerebral ischemia, or previous ventricular tachyarrhythmias." They did not define the concurrent benefits for the regiment of patients who did not escape the test.My own review of the carotid sinus syndrome literature3 cited many more reports of patients who suffered stroke, death by stroke, ventricular dysrhythmia, and death by ventricular fibrillation or asystole. One group of authors4 stated that one third