{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T23:55:28Z","timestamp":1789084528958,"version":"build-2803163510"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The risk of stroke after carotid sinus massage is greater if there is preexisting carotid stenosis or carotid plaques. We present the case of a patient with underlying 40% carotid stenosis, who developed a watershed stroke after a self-neck massage in our stroke unit. We show a well-documented case with magnetic resonance images before and after the neck massage. We report a case of a watershed brain infarct after a self-massage of the carotid sinus, with preexisting carotid artery stenosis. Neck massage continues to be a significant cause of stroke and should therefore not be performed by patients. Clinicians must be aware of the implications of a carotid sinus massage in both the outpatient and inpatient settings.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We admitted a 58-year-old white male patient, with no relevant medical history, to our department with a brain stem infarct. During his stay at our stroke unit, the patient performed a self-neck massage with consecutive bradycardia and asystole, resulting in left-side hemiparesis. The underlying cause of the hemodynamic stroke is believed to be secondary to this intensive neck massage performed by the patient. The patient also suffered from unknown right internal carotid artery stenosis. <\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Clinicians and patients must be aware that neck massage can lead to ischemic stroke. We postulate that repetitive impaired cardiac output can lead to a hemodynamic (watershed-type) stroke.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-021-02680-1","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:10:08Z","timestamp":1614039008000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Ischemic stroke secondary to self-inflicted carotid sinus massage: a case report"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9237-9000","authenticated-orcid":false,"given":"Edgar R.","family":"Lopez-Navarro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6tz","family":"Greif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl-Albrecht","family":"Haensch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Ringelstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Larbig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"issue":"10","key":"2680_CR1","doi-asserted-by":"publisher","first-page":"e437","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.05.005","volume":"23","author":"AP Tan","year":"2014","unstructured":"Tan AP, Taneja M, Seah BH, Leong HN, Venketasubramanian N. Acute free-floating carotid artery thrombus causing stroke in a young patient: unique etiology and management using endovascular approach. J Stroke Cerebrovasc Dis. 2014;23(10):e437\u20139.","journal-title":"J Stroke Cerebrovasc Dis."},{"key":"2680_CR2","unstructured":"Standring S. Gray's anatomy: Elsevier; 2016."},{"key":"2680_CR3","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/B978-0-323-47873-1.00074-7","volume-title":"Abernathy's surgical secrets","author":"MK Suh","year":"2018","unstructured":"Suh MK, Baxter BT. Carotid disease. In: Abernathy\u2019s surgical secrets. Amsterdam: Elsevier; 2018. p. 345\u20138."},{"key":"2680_CR4","volume-title":"Textbook of histology","author":"LP Gartner","year":"2021","unstructured":"Gartner LP. Textbook of histology. 5th ed. Amsterdam: Elsevier; 2021.","edition":"5"},{"issue":"12","key":"2680_CR5","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1097\/01.SMJ.0000145391.86504.CC","volume":"97","author":"AC Grant","year":"2004","unstructured":"Grant AC, Wang N. Carotid dissection associated with a handheld electric massager. South Med J. 2004;97(12):1262\u20133.","journal-title":"South Med J."},{"key":"2680_CR6","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-222169","author":"J Kaur","year":"2017","unstructured":"Kaur J, Singla M, Singh G, Singh G. Frequent neck massage leading to bilateral anterior cerebral artery infarction. BMJ Case Rep. 2017. https:\/\/doi.org\/10.1136\/bcr-2017-222169.","journal-title":"BMJ Case Rep."},{"issue":"2","key":"2680_CR7","doi-asserted-by":"publisher","first-page":"e8","DOI":"10.4081\/ni.2011.e8","volume":"3","author":"CM Lin","year":"2011","unstructured":"Lin CM. Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis. Neurol Int. 2011;3(2):e8.","journal-title":"Neurol Int."},{"issue":"1","key":"2680_CR8","doi-asserted-by":"publisher","first-page":"65","DOI":"10.24920\/J1001-9242.2007.009","volume":"34","author":"WJ Chen","year":"2019","unstructured":"Chen WJ, Qiao HY, Fang GT, Zhong X. Vertebral artery dissection probably caused by massage: a case report. Chin Med Sci J. 2019;34(1):65\u20138.","journal-title":"Chin Med Sci J."},{"key":"2680_CR9","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.wneu.2018.04.008","volume":"115","author":"G Dutta","year":"2018","unstructured":"Dutta G, Jagetia A, Srivastava AK, Singh D, Singh H, Saran RK. \u201cCrick\u201d in neck followed by massage led to stroke: uncommon case of vertebral artery dissection. World Neurosurg. 2018;115:41\u20133.","journal-title":"World Neurosurg."},{"issue":"6","key":"2680_CR10","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.ajem.2015.02.047","volume":"33","author":"NA Collins","year":"2015","unstructured":"Collins NA, Higgins GL 3rd. Reconsidering the effectiveness and safety of carotid sinus massage as a therapeutic intervention in patients with supraventricular tachycardia. Am J Emerg Med. 2015;33(6):807\u20139.","journal-title":"Am J Emerg Med."}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-02680-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13256-021-02680-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-02680-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:33:45Z","timestamp":1614040425000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-021-02680-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,23]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2680"],"URL":"https:\/\/doi.org\/10.1186\/s13256-021-02680-1","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,23]]},"assertion":[{"value":"8 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in accordance with the fundamental principles of the Declaration of Helsinki.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtain from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"83"}}