Funabashi Sayaka, Yamagata Kenichiro, Nishii Tatsuya, Kusano Kengo
Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
Department of Radiology, National Cerebral & Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
Eur Heart J Case Rep. 2021 Jan 4;5(1):ytaa430. doi: 10.1093/ehjcr/ytaa430. eCollection 2021 Jan.
Head and neck malignancies rarely cause reflex syncope. Three mechanistic patterns of reflex syncope are known in such patients: carotid sinus syndrome, glossopharyngeal neuralgia syndrome, and parapharyngeal space lesions syncope syndrome. There are few reports describing parapharyngeal space lesions syncope syndrome.
A 61-year-old man with a history of head and neck cancer underwent left lingual resection and left anterior cervical lymph node dissection followed by chemoradiotherapy. Two months later, he experienced his first syncope and was admitted to our hospital for further investigation. During the first few days in the hospital, he experienced loss of consciousness. Carotid artery massage and cervical rotation-extension examinations revealed no abnormalities, and glossopharyngeal neuralgia was not observed. Cervical computed tomography showed recurrence of tongue cancer infiltrating the para-nasopharyngeal space. Consequently, the patient had sinus pause during the loss of consciousness; hence, we suspected parapharyngeal space lesions syncope syndrome. Pacemaker implantation was considered but could not be performed as the patient passed away because of the original malignancy.
Parapharyngeal space tumours are often characterized by the absence of subjective symptoms, although symptoms such as neck swelling and discomfort in the throat have been reported. Parapharyngeal space lesions syncope syndrome is caused by tumour invasion into the parapharyngeal space, and there is no known trigger for syncope. Our case is unique because the patient's first symptom of recurrence of tongue cancer infiltrating the para-nasopharyngeal space was repeated loss of consciousness.
头颈部恶性肿瘤很少引起反射性晕厥。此类患者已知有三种反射性晕厥的机制模式：颈动脉窦综合征、舌咽神经痛综合征和咽旁间隙病变晕厥综合征。关于咽旁间隙病变晕厥综合征的报道很少。
一名有头颈部癌症病史的61岁男性接受了左舌切除术和左颈前淋巴结清扫术，随后进行了放化疗。两个月后，他首次出现晕厥，被收治入院进一步检查。在住院的头几天里，他出现了意识丧失。颈动脉按摩和颈部旋转伸展检查未发现异常，也未观察到舌咽神经痛。颈部计算机断层扫描显示舌癌复发并侵犯鼻咽旁间隙。因此，患者在意识丧失期间出现窦性停搏；因此，我们怀疑是咽旁间隙病变晕厥综合征。考虑过植入起搏器，但由于患者因原发性恶性肿瘤去世而未能进行。
咽旁间隙肿瘤通常无主观症状，不过也有报道称会出现颈部肿胀和咽喉不适等症状。咽旁间隙病变晕厥综合征是由肿瘤侵犯咽旁间隙引起的，目前尚不清楚晕厥的触发因素。我们的病例很独特，因为患者舌癌复发侵犯鼻咽旁间隙的首发症状是反复的意识丧失。
