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Left hemispheric cortical watershed infarcts triggered by carotid sinus self-massage
  1. Georg Haber1,
  2. Miriam Loffeld1,
  3. Magret Braumiller1 and
  4. Stefan Lorenzl1,2
  1. 1Neurology, Krankenhaus Agatharied GmbH, Hausham, Bavaria, Germany
  2. 2Paracelsus Medizinische Privatuniversität, Salzburg, Austria
  1. Correspondence to Professor Stefan Lorenzl; stefan.lorenzl{at}


A 69-year-old man was presented to our emergency department with acute onset of hemianopsia, aphasia and dizziness. He reported that while he was sitting in front of his computer at home, he had performed a bilateral self-massage of his carotid arteries when suddenly the symptoms occurred. A neurological examination revealed a hemianopsia with a visual field loss on the right side. In addition, a mild aphasic syndrome with agraphia and a word-finding disorder (National Institutes of Health Stroke Scale (NIHSS): 3 points) was diagnosed. The initial brain CT scan with CT angiography showed neither an intracerebral haemorrhage nor a cerebral infarction. Also, no occlusion or any signs of artery dissection or a flow relevant stenosis of the brain supplying arteries were found. After excluding other contraindications, an intravenous thrombolysis with weight-adapted alteplase was performed. The symptoms of the patient significantly improved in the short-term follow-up. Three days after admission no neurological deficits remained. The MRI of the brain revealed multifocal, small, left hemispherical strokes in the middle cerebral artery territory. In general, watershed infarcts after carotid sinus self-massage follow a rare ischaemic stroke mechanism. This case emphasises the importance of a detailed anamnestic evaluation to determine the aetiological classification of ischaemic stroke as well as educating patients’ (poststroke) behaviour.

  • neuroimaging
  • stroke
  • neurology

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  • Contributors GH planned, conducted and wrote the case report and did the main work. MB and ML treated the patient on the stroke unit and normal ward. They performed and arranged the investigations and reported the results. SL reviewed the work and helped to interpret the data and results.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.