Vasodepressive carotid sinus hypersensitivity with head and neck malignancy: Treatment with propranolol

Hawkins, Jean E.; Lewis, H. Daniel; Emmot, William W.; Vacek, James L.

doi:10.1016/0002-8703(91)90785-g

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Syncope from HNC is uncommon, and there are several previous reports to describe it 6,7. Most reported cases of syncope are caused by carcinoma, but neurofibroma and lymphoma have also been reported 8,9.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Syncope with Chemotherapy Irresponsive to Cardiac Pacemaker in Head and Neck Cancer

Kang

Kim

et al. 2009

Yonsei Med J

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Recurrent syncope as a complication of recurrent neck malignancy is an uncommon but well documented association. The syncope is presumed to occur when a tumor mass invades the baroreceptor within the carotid sinus or when it disrupts the afferent nerve fibers of the glossopharyngeal nerve. A 59-year-old man presented with recurrent syncope and headache. He had a wide local excision including tonsillectomy and modified left radical neck dissection for tonsilar cancer 4 years ago. A computed tomography scan revealed ill-defined lesions in left parapharyngeal, carotid space and right upper jugular region. After clinical evaluation, cardiac pacemaker was placed, but he still suffered from the syncope. Then, he received the chemotherapy with docetaxel and cisplatin. The last hypotension event occurred on day 10 of the chemotherapy. Six months after 3 cycles of chemotherapy, he remained in complete remission and resolution of syncope. We report a case in which syncope was associated with a recurrence of tonsilar cancer and successfully treated with chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Successful Treatment of Syncope with Chemotherapy Irresponsive to Cardiac Pacemaker in Head and Neck Cancer

Kang

Kim

et al. 2009

Yonsei Med J

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“…11 The medical treatment of the vasodepressor type remains highly unsatisfactory although there have been case reports of limited success with beta blockade either alone or in combination with ephedrine. 12 Surgical denervation of the carotid sinus has also been tried as an option. 13 In patients with head and neck cancer, induction chemotherapy by has been shown to be a successful treatment option for syncope.…”

Section: Discussionmentioning

confidence: 99%

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

Maddineni¹,

Panda²

2007

J GEN INTERN MED

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Syncope associated with the act of swallowing (deglutition syncope) and syncope associated with head and neck cancers have been documented independently. We present a case of syncope precipitated by a combination of both these mechanisms. It is important to recognize the coexistence of different hemodynamically significant mechanisms leading to syncope. A 66-year-old male recently diagnosed with head and neck cancer presented with syncope associated with eating. Diagnosis was complicated because of multiple factors in this patient, which individually could have led to syncope. The patient was on beta-blocker therapy, had a neck mass, and the episodes were associated with swallowing. Our hypothesis is that all these etiologies together led to the events but not in their typical mechanisms and raises the possibility that swallowing can be considered a carotid massage equivalent in patients with neck masses not physically extending to the carotid sinus.KEY WORDS: swallowing; head and neck cancer; carotid massage.

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“…Cases of head and neck malignancies have been reportedly associated with syncope related with CSS [27], as well as documented changes in baroreceptor sensitivity [37] suggesting a peripheral mechanism. Tea et al elegantly demonstrated the presence of sternocleidomastoid muscle denervation that was closely correlated with the presence of CSS [52].…”

Section: Classification and Pathophysiologymentioning

confidence: 99%

“…In 10-25 % of elderly patients with undiagnosed syncope, a positive response to CSM (as previously defined, without reproduction of symptoms) is the only abnormal finding [28,34], even after extensive, invasive electrophysiologic testing [11,13,38]. In most cases, there is no predisposing condition; however, it can be the result of tumors or aneurysms of the head and neck [27]. CSH is more frequent in diabetics, patients with coronary and carotid atherosclerosis, and is more prevalent in males by a ratio of 4:1 [1,43,50].…”

Section: Epidemiology and Clinical Featuresmentioning

confidence: 99%

The management of patients with carotid sinus syndrome: is pacing the answer?

2004

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Carotid sinus syndrome (CSS) is an under recognized cause of recurrent unexplained syncope and potentially of recurrent falls in the elderly. The mechanisms that lead to syncope in patients with CSS remain debated. However, evidence for both peripheral and central alterations have been recently reported. The diagnosis of CSS is challenging and a high clinical suspicion is usually needed to make the diagnosis. Clinical presentation may be typical and characterized by a clear association between accidental manipulation of the carotid sinus and the presentation of syncope. On the other hand, recurrent unexplained syncope and unexplained falls may be the clinical presentation of patients with CSS without a specific trigger. Carotid sinus hypersensitivity documented by carotid sinus massage (CSM) may be the only finding indicating the possibility of CSS as the cause of syncope. In older patients with recurrent unexplained syncope and a negative diagnostic work-up, carotid sinus massage both in the supine and upright positions is recommended. CSS may present primarily as a cardioinhibitory response or a true vasodepressor response. Therapy should address any underlying pathology if present, and be directed to either prevent cardioinhibition, vasodepression or both alterations. A variety of medical therapies have been used with unclear effects. No appropriately designed controlled clinical trials have been performed comparing pacing with medical therapy. Nonetheless, available information indicates that pacing may have a strong beneficial effect and prevents recurrence of syncope in patients with CSS. The present paper critically reviews the latest insights in the pathophysiology, diagnosis and management of CSS.

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Vasodepressive carotid sinus hypersensitivity with head and neck malignancy: Treatment with propranolol

Cited by 6 publications

References 11 publications

Successful Treatment of Syncope with Chemotherapy Irresponsive to Cardiac Pacemaker in Head and Neck Cancer

Successful Treatment of Syncope with Chemotherapy Irresponsive to Cardiac Pacemaker in Head and Neck Cancer

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

The management of patients with carotid sinus syndrome: is pacing the answer?

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