A Case of Neurally Mediated Syncope Caused by Cervical Malignant Lymphoma

Abstract

We report herein on a case of a 74 year old male with neurally mediated syncope caused by cervical malignant lymphoma. He visited our hospital complaining of a rapidly-growing left cervical mass. Local findings showed an elastic soft mass with tenderness in his cervical region. We performed an open biopsy and pathological diagnosis was diffuse large B-cell lymphoma, so we planned to treat him with CHOP therapy. But before chemotherapy, loss of consciousness occurred. This syncope was considered to be neurally mediated syncope caused by the compression of the carotid sinus by the cervical malignant lymphoma. His cervical malignant lymphoma rapidly shrank after CHOP therapy, and general fatigue and bradycardia decreased day by day. If cardiac pacemaker insertion is not enforced for a case of neurally mediated syncope, the frequency of the syncope increases. In this case the cervical tumor was reduced by CHOP therapy and the syncope and bradycardia disappeared. The patient was able to avoid cardiac pacemaker insertion.

An Unusual Initial Presentation of Diffuse Large B-Cell Lymphoma as Recurrent Syncope

“…To our knowledge, there are 7 reported cases of lymphoma presenting as syncope without direct cardiac involvement (3 cases of diffuse large B-cell lymphoma [4][5][6], 2 of primary mediastinal lymphoma [9,10], and 2 of Hodgkin's lymphoma [11,12]). All previously reported cases were found to have mechanical infiltrates or vascular compromise from the mass.…”

“…So far, most of these reported cases were in patients with recurrent head and neck cancer. Syncope from DLBCL without cardiac involvement, despite its frequent cervical involvement, has been only reported in 3 cases thus far to our knowledge [4][5][6].…”

Tonsillar Inflammation, a Rare Cause of Bradycardia and Hypotension

“…Stimulation of the carotid sinus leads to stretching of the baroreceptors, resulting in impulse conduction through the afferent nerve of Hering, to the Nucleus trachus Solitarius (brainstem) and then via the vagus. Subsequently, bradycardia ensues [4][5][6][7][8][9][10]. Overstimulation due to external and internal mechanical compression leads to the carotid sinus syndrome [2].…”