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[Fainting caused by a neck tumor]
J B Winter1, R M M Gevers, A Huitema
1Universitair Medisch Centrum Utrecht, Hart-Long Centrum, afd. Cardiologie, Postbus 85.000, 3508 GA Utrecht. j.b.winter@hli.azu.nl
Nederlands Tijdschrift Voor Geneeskunde
|February 28, 2002
Summary
A neck tumor caused intermittent carotid sinus syndrome in an elderly woman, leading to dizziness and fainting. Treatment included a pacemaker and radiotherapy for the non-Hodgkin lymphoma.
Area of Science:
- Cardiology
- Neurology
- Oncology
Background:
- Carotid sinus hypersensitivity can cause syncope, but is often idiopathic or associated with aging.
- Parapharyngeal space tumors are rare and can present with diverse neurological symptoms due to mass effect.
Observation:
- An 86-year-old woman presented with recurrent dizziness, falls, and near-syncope.
- Symptoms were triggered by eating and head turning, accompanied by episodes of bradycardia and asystole.
- A left parapharyngeal tumor compressing the carotid artery was identified via CT scan.
Findings:
- Histological examination confirmed a low-grade malignant non-Hodgkin lymphoma.
- The tumor was causing intermittent carotid sinus stimulation due to its location and mass effect.
- The patient experienced symptomatic sinus bradycardia and asystole secondary to lymphoma-induced carotid massage.
Implications:
- This case highlights a rare presentation of carotid sinus syndrome secondary to a parapharyngeal non-Hodgkin lymphoma.
- Prompt diagnosis and management, including pacemaker insertion and radiotherapy, are crucial for favorable outcomes.
- The findings underscore the importance of considering extrinsic compression in the differential diagnosis of unexplained bradycardia and syncope.