Yonsei Med J.  2009 Oct;50(5):725-728. 10.3349/ymj.2009.50.5.725.

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

• Ju JH
• Kang MH
• Kim HG
• Lee GW
• Park JJ
• Kim JP
• Kang JH

• KMID: 1103831
• DOI: http://doi.org/10.3349/ymj.2009.50.5.725

Abstract

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.

Keyword

Syncope; head and neck cancer; chemotherapy

MeSH Terms

Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Carcinoma, Squamous Cell/*complications/drug therapy/radiography
Cisplatin/*therapeutic use
Head and Neck Neoplasms/*complications/drug therapy/radiography
Humans
Male
Middle Aged
Neoplasm Recurrence, Local/*complications/drug therapy
*Pacemaker, Artificial
Syncope/*drug therapy/etiology
Taxoids/*therapeutic use
Tonsillar Neoplasms/*complications/drug therapy/radiography

Figure

• 

  Fig. 1 A 24 hr Holter monitoring showed long sinus pauses for up to 3 seconds.

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  Fig. 2 A computed tomography scan revealed ovoid mass lesion compressing the left internal carotid artery.

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  Fig. 3 A computed tomography scan performed after 3 cycles of chemotherapy showed a considerable reduction of the mass which compresses the left internal carotid artery.

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