Convulsive Syncope From Carotid Sinus Syndrome as a Manifestation of Laryngeal Cancer

Abstract

Objective: Carotid sinus syndrome (CSS) is a rare yet serious presentation of head and neck malignancy. To our knowledge, syncope and seizure-like episodes as a manifestation of carotid sinus syndrome secondary to laryngeal cancer has not been reported to date. We report a case of laryngeal cancer causing convulsive syncope masquerading as seizures due to CSS. Methods: Case report. The patient’s medical record was reviewed for demographic and clinical information. Results: A 62-year-old male presented with multiple episodes of syncope and hoarseness of voice. On nasoendoscopic examination, left vocal cord palsy and left aryepiglottic fold tumor were visualized. Computerized tomography (CT) neck showed a large 2.4 × 3.6 cm left supraglottic tumor with local invasion and extensive cervical lymphadenopathy compressing the carotid sinus. CT guided biopsy of the tumor revealed invasive squamous cell carcinoma. While undergoing evaluation, the patient developed seizure-like episodes. Inpatient telemetry monitoring revealed significant bradycardia and hypotension during these episodes. A permanent pacemaker was inserted which resulted in resolution of the syncopal and seizure-like episodes. Conclusion: In patients with unexplained syncope or seizure-like episodes and a background of head and neck cancer, clinicians should consider the diagnosis of CSS. CSS is a poor prognostic factor due to the associated higher stage of disease.