Vasodepressor Syncope and Recurrent Carcinoma of Pharynx: A Sign of Malignant Recurrence

We present the case of a 66-year-old man under surveillance for oropharyngeal malignancy. The presentation was that of recent onset recurrent syncopal attacks associated with neck pain. Both bradycardia and hypotension were seen during the syncopal events. Although recurrence of malignancy had not been proven at the time of presentation, this was subsequently confirmed. In this case syncope was successfully managed with Midodrine, and permanent pacemaker implantation was avoided. A review of the literature identified similar cases, where the presumptive mechanism for syncope is mediated via the glossopharyngeal nerve. Such cases follow a similar clinical course, with an unpredictable response to standard therapies, including pacemaker implantation. Clinicians should be aware that syncope associated with head and neck cancer may herald recurrence of malignancy.