This case illustrates a profound vasodepressor reaction causing syncope in a patient with glossopharyngeal metastasis, which was not prevented by a pacemaker.
Vasodepressor syncope may persist despite pacing in glossopharyngeal metastasis; leaves open tilt-table testing utility for mechanism confirmation in atypical cases.
Figure 1. Neurocardiogenic (Vasodepressor) Syncope. A 72-year-old woman with breast cancer that had metastasized to the glossopharyngeal region had recurrent episodes of sudden lightheadedness, diaphoresis, and syncope. A dual-chamber pacemaker was implanted, but syncope recurred, always preceded by severe neck pain. During the tilt-table test with the pacemaker inactivated, the results of which are shown here, the patient's usual symptoms developed. She lost consciousness and had a seizure, but regained consciousness immediately after she was returned to the supine position. The study shows a profound vasodepressor reaction with minimal slowing of the sinus rhythm. Treatment with disopyramide (150 mg three . . .
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Eagle et al. (1993) studied this question.
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