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In the elderly, a transient ischemic attack (TIA) and a hypersensitive carotid sinus reflex (HCSR) often co-exist and can pose a diagnostic challenge. Seven cases are presented. HCSR is a relative condition; besides increased irritability of the receptor or target organs, susceptibility of the nerve center to ischemia probably is induced by a slow heart rate or low blood pressure in any patient with pre-existing occlusive cerebrovascular disease. Dizziness and syncope of this type represent hemodynamic TIA in contrast to thromboembolic TIA. The carotid sinus massage test is recommended for differentiating the two types of TIA; the treatments differ. At present there is no uniform management that can be applied to either TIA or HCSR routinely. Therefore, treatment should be approached on an individual basis, keeping in mind the different pathophysiologic factors operating in the specific patient.

Carotid artery pulse curve changes have been studied in relation to central events such as valvular diseases, stroke volume or myocardial contractility, and peripheral events such as arteriosclerosis, hypertension or aging of arteries.However, little is known about whether the carotid pulse curve is affected by local events, i.e. discrete arteriosclerosis or the occlusion of one particular carotid artery. Localized arteriosclerosis of an internal carotid artery has long been recognized as one of the most frequent lesions of the general arterial system,' and the occlusive disease is very frequently noted at the origin of internal carotid arteries.2 2We have had many opportunities to study the carotid pulse curve of patients with carotid artery occlusive disease to see whether the local arterial changes were reflected in the pulse curves. Although, with the present method of recording, no unequivocal criteria were found to detect the occlusion, statistical analysis of the curves revealed a finding which has not been reported in the past, but which is significant enough to urge further investigation. This paper deals with that finding. MATERIALThe subjects were adult patients admitted to the Long Beach Veterans Administration Hospital who had complete strokes or transient ischemic attacks and in whom four-vessel angiographic examinations were performed to evaluate the status of the extracranial cerebral artery system. In addition, similar patients from the same hospital who showed no sign of arterial disease and also healthy medical students were studied as controls. The internal and external carotid arteries shown in both right and left posterior oblique views of all the four-vessel angiograms were examined, and those showing more than 50% narrowing of the lumen in one of the two views were considered as &dquo;occlusive&dquo; and the rest of the arteries were considered as &dquo;non-occlusive&dquo;. All patients who underwent angiographic examination had varied degrees of either arteriosclerosis or systemic hypertension, and those who had &dquo;non-occlusive&dquo; carotid arteries were taken as arteriosclerotic controls. No angiographic studies were made of the normal control group. Three groups of individuals were established for statistical analysis: 1.) occlusive: 22 cases with mean age 59. 2.) non-occlusive arteriosclerotic controls: 21 cases with mean age 61. 3.) normal controls: 18 cases with mean age 29. METHOD