Vasodepressor carotid sinus syncope associated with a neck mass.
We present the hemodynamic and autonomic features of recurrent purely vasodepressor syncope episodes in a patient with left-sided malignant cervical adenopathy involving the carotid sinus. Extreme hypotension lasting 10 to 30 minutes, without change in heart rate, occurred spontaneously and 20 seconds after head-turning. The baseline respiratory sinus arrhythmia, heart rate response to standing and Valsalva's maneuver, and cold-induced blood pressure elevation were normal, indicating normal baroreceptor function between episodes. The episodes abated after 1 week of bedrest but reappeared within 1 day of discharge from the hospital. Syncope no longer occurred after intracranial section of the left glossopharyngeal nerve and upper rootlets of the left vagus. Autonomic testing remained normal postoperatively. A review of the literature indicates that purely vasodepressor syncope has been more common with left carotid sinus lesions.
Frank
J I
JI
Neurology Division, St. Elizabeth's Hospital, Boston, MA.
Ropper
A H
AH
Zuniga
G
G
D001794:Blood Pressure; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D002346:Carotid Sinus / Q000503:physiopathology*; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013575:Syncope / Q000209:etiology*