The unforeseen danger of a seemingly benign act: A case of self-induced ischemic stroke following carotid sinus massage

Abstract

This case report describes an unusual ischemic stroke in a man in his seventies, triggered by self-massage of the carotid artery while checking his pulse. He had no known vascular risk factors but was later found to have moderate carotid stenosis. The stroke, confirmed by neuroimaging, was likely caused by either a ruptured plaque or repeated stimulation of the carotid sinus leading to cerebral hypoperfusion.This case highlights the dangers of neck massage, even in individuals without prior vascular disease. It emphasizes the need for public and clinician education about the risks of carotid sinus manipulation. While carotid sinus massage can be a useful clinical tool, it should only be performed by trained professionals and followed by a clinical evaluation.Thorough patient history taking is crucial, as even seemingly harmless actions like checking one's pulse can be relevant to diagnosis. Earlier mention of the self-massage might have led to faster, targeted vascular imaging.This case adds to the growing evidence of ischemic stroke following carotid sinus massage. While rare, this complication can be serious. Increased awareness can help prevent such incidents. Patients should avoid neck manipulation, and clinicians should exercise caution when performing carotid sinus massage, especially in those with suspected or known carotid artery disease.Finally this case of self-induced ischemic stroke following carotid sinus massage serves as a potent reminder that seemingly benign actions can have serious consequences, especially in the context of undiagnosed vascular disease. It highlights the critical importance of thorough patient history taking, clinician awareness of rare complications, and public education regarding the potential dangers of neck manipulation. Furthermore, this case underscores the need for clinicians to consider unusual etiologies when evaluating patients presenting with stroke symptoms, ensuring a comprehensive diagnostic approach.