Syncope from head and neck cancer

Abstract

We have examined 17 patients suffering from recurrent syncope caused by carcinoma of the head and neck. The tumor originated in the mouth in seven, larynx in six, nasopharynx in three and parotid gland in one, and involved cervical lymph nodes at diagnosis in 12. Sixteen patients had previously had radical neck dissections and 12 had had radiation therapy. Recurrent carcinoma was present in 16. Spells resolved spontaneously in four, improved with treatment in 11 and continued in two. The syncope was spontaneous in 15 and induced only by suctioning or carotid sinus massage in two. Suctioning also produced attacks in four others, as did carotid sinus massage in five of ten tested. Acute severe unilateral head or neck pain preceded spontaneous syncope in 11. Sixteen patients had both profound bradycardia and hypotension during most spells, but ten had syncope with hypotension only, either spontaneously or following cardiac pacing or atropine to prevent bradycardia. Seizure activity accompanied syncope in eight. Anticholinergics improved 7/12, carbamazepine 2/5, carotid ligation 1/1 and intracranial sectioning of the glossopharyngeal nerve 1/1. Local radiation may have helped 4/10. Cardiac pacing was ineffective in 3/3 due to the development of pure vasodepressive syncope. Autopsy in 2/2 showed tumor involving the glossopharyngeal and vagus nerves. Syncope in these patients is under-recognized, frequently is due to vasodepression, and suggests recurrent carcinoma.

Swallowing: Is It a Carotid Massage Equivalent Causing Syncope in Patients With Neck Masses?

“…Induction chemotherapy was chosen over Surgery or radiotherapy because Surgery is often palliative only and radiotherapy poses the risk of a syncopal event in an unmonitored environment. 15,16 Our patient did not have any further episodes of syncope.…”

Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

“…Conditions in this group comprise neurocardiogenic (vasovagal) syncope, situational syncope, carotid sinus syndrome and glossopharyngian neuralgia [3]. Malignancy-related reflex syncope is rare: in a series of 4,500 patients with cancer of the head and neck, the prevalence of syncope was estimated at 0.4% [4]. Patients with advanced tumoral disease at diagnosis and those with a history of neck surgery appear to be at greater risk of developing syncope [4].…”

“…Malignancy-related reflex syncope is rare: in a series of 4,500 patients with cancer of the head and neck, the prevalence of syncope was estimated at 0.4% [4]. Patients with advanced tumoral disease at diagnosis and those with a history of neck surgery appear to be at greater risk of developing syncope [4]. Syncope may be an early sign of neck or cervical cancer [5] and even the sole sign of recurrent disease [6].…”

Vasodepressor Syncope from Neck Cancer with Associated C‐6 Dermatome Neuralgia

“…Macdonald et al 2 reported 17 patients with recurrent syncopc from more than 4500 patients with head and neck cancer seen over a 12-year period, an incidence of less than 0.4%; however, half the patients were seen during the last 2 years, suggesting underrecognition of the problem. The tumor arose in the mouth in 7, the larynx in 6, nasopharynx in 3, and the parotid gland in 1 patient(s).…”

“…It is presumed, therefore, that invasion of the regional neurovascular bundle occurred, with involvement of the left vagus as well as regional sympathetic nerves. This resulted in intermittent afferent impulses causing efferent: (1) sympathetic inhibition with vasodepressor response5 and, (2) variable, but usually mild, parasympathetic cardioinhibitory effects.…”