Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

Abstract

Syncope is caused by a wide variety of disorders. Recurrent syncope as a complication of malignancy is uncommon and may be difficult to diagnose and to treat. Primary neck carcinoma or metastases spreading in parapharyngeal and carotid spaces can involve the internal carotid artery and cause neurally mediated syncope with a clinical presentation like carotid sinus syndrome. We report the case of a 76-year-old man who suffered from recurrent syncope due to invasion of the right carotid sinus by metastases of a carcinoma of the esophagus, successfully treated by radiotherapy. In such cases, surgery, chemotherapy or radiotherapy can be performed. Because syncope may be an early sign of neck or cervical cancer, the diagnostic approach of syncope in patients with a past history of cancer should include the possibility of neck tumor recurrence or metastasis and an oncologic workout should be considered.

Pulmonary tumor thrombotic microangiopathy presenting as recurrent syncope

“…12 Neurally mediated syncope can be triggered in the carotid sinus or gastrointestinal tract and leads to activation of the autonomic efferent pathway that causes an increase in parasympathetic or sympathetic activity, resulting in a "vasodepressor type" if hypotension and vasodilation predominates, or a "cardio-inhibitory type" when bradycardia or asystole predominates. 5 Gastrointestinal causes of recurrent syncope have been reported 13,14 and could have been contributory in our patient since there was direct tumor invasion to esophagus and gastric soft tissue on autopsy. With bladder incontinence and stiffening of extremities as presenting features, seizure is a consideration for TLOC, but with a Calgary Syncope Diagnostic Questionnaire 15 score < 1 and a non-diagnostic electroencephalogram (EEG) in this case, syncope is more likely than seizures.…”

Case report: Recurrent syncope as initial symptom in a patient with neck lymphoma

“…The pathophysiological mechanisms involved in syncope-associated CSS are complex ( 6 ). The carotid baroreceptor, located at the bifurcation of the carotid artery, is sensitive to mechanical pressure.…”

Metastatic esophageal cancer presenting as shock by injury of vagus nerve mimicking baroreceptor reflex

“…On the contrary, the possibility of bradycardia and hypotension due to direct cardiac effects through injury to the efferent vagus nerve was considered low, because the sinoatrial node is predominantly supplied by the right vagus nerve. [ 8 , 9 ] The patient initially presented with left neck pain just before shock status. Pain is generally the cause of neurally mediated syncope.…”