Transient ischaemic attacks related to carotid stenosis precipitated by straining, bending, and sneezing

Abstract

SummaryThree patients are described in whom one or more carotid territory transient ischaemic attacks (TIAs) were preceded by sneezing, straining, or bending over. It is argued that the mechanism involved dislodgment of embolic material from the site of carotid atheroma. This mechanism should be considered as an alternative to paradoxical embolism when TIAs are precipitated by such physiological manoeuvres. Furthermore, TIAs should be added to the list of medical hazards associated with such events.

Paroxysmal Sneezing at the Onset of Syncopes and Transient Ischemic Attack Revealing a Papillary Cardiac Fibroelastoma

“…Like coughing, sneezing is a well-recognized but hardly common cause of syncope; the previously suggested mechanism of a neurally mediated situational syncope is transient venous obstruction due to increased intrathoracic pressure, which may contribute to cerebral hypoperfusion [ 15 ]. In fact, sneezing, as in the Valsalva manoeuvre, is associated with increased intrathoracic pressure, arterial pressure rising to 80–90 mmHg [ 1 ], and venous pressure as well. Furthermore, the rise in intrathoracic pressure is associated with a rise in intracranial pressure [ 1 ].…”

“…In fact, sneezing, as in the Valsalva manoeuvre, is associated with increased intrathoracic pressure, arterial pressure rising to 80–90 mmHg [ 1 ], and venous pressure as well. Furthermore, the rise in intrathoracic pressure is associated with a rise in intracranial pressure [ 1 ]. Moreover, it has been confirmed that coughing diminishes phasic carotid blood velocity and reduces cerebral perfusion [ 16 ].…”

“…Moreover, it has been confirmed that coughing diminishes phasic carotid blood velocity and reduces cerebral perfusion [ 16 ]. In the past, “inability to sneeze” was observed after cerebral lesions [ 4 , 5 ] and a variety of neurological disorders (other than syncope) were reported after sneezing; they included vertigo and deafness, subarachnoid haemorrhage and headache, drop attacks (in cases of Arnold-Chiari malformation), cerebrospinal fluid rhinorrhoea and pneumocephalus, or sudden quadriplegia after acute cervical disc herniation [ 1 , 17 ]. Cardiovascular complications were likewise reported after sneezing; they included coronary artery spasms, acute aortic dissection [ 18 ], and cerebral ischaemic stroke [ 19 ].…”

“…Sneezing is a protective physiological respiratory reflex that consists of a sequence of mouth closing, a single slow deep inspiration or series of inspiratory efforts, and then an explosive expiratory effort with closed glottis [ 1 ]; the consequence is increased intrapulmonary pressure [ 2 ]. However, this phenomenon can be modulated by voluntary cortical activity [ 3 ].…”

The Dangers of Sneezing: A Review of Injuries

“…There were 10 cases of intracranial/neurological injury after sneezing which included pneumocephalus 38 (1), cerebral venous thrombosis 30,33 (2), vertebral TIA 35 (1), migraine trigger 29,36 (2), transient ischemic attack 32 (1), spinal epidural hematoma 34,37 (2), and upper cervical infarction 31 (1). Sixty percent of these cases were in male patients.…”