Syncope and tumours in the neck: carotid sinus or glossopharyngeal syndrome?

Three patients with syncope, lateral cervical metastasis and/or carotid sinus hypersensitivity are described. The initial diagnosis in these patients was carotid sinus syndrome (CSS). Further investigations, including computerized tomography, showed in all the patients a malignant tumour localized in the epipharynx or nearby. We think that the symptomatology in our patients can be attributed to the epipharyngeal tumour. The mechanism of the attacks could be similar to that which operates in the glossopharyngeal neuralgia-asystole syndrome, but does not involve pain pathways. The clinical picture in our patients was quite different from the classic CSS; the vaso-vagal attacks were more prolonged, severe, and relapsing and were mainly vasodepressor. Symptoms were not improved by demand ventricular pacing, but A-V sequential pacing achieved a moderate improvement in two patients.