Objective:

To present a case of carotid sinus syndrome secondary to laryngeal cancer. 

Background:

The carotid sinus reflex, whose afferent arm is mediated by baroreceptors in the arterial wall of the proximal internal carotid artery, plays a key role maintaining homeostasis of cerebral perfusion.  Carotid sinus syndrome–a symptomatic hypersensitivity of this reflex–can lead to marked bradycardia and syncope.  We discuss a rare case of carotid sinus syndrome due to laryngeal cancer manifesting in recurrent sinus arrest and syncope. 

Design/Methods:

NA

Results:

A 63-year-old male, with a past medical history of laryngeal cancer treated with chemotherapy, radiation, and laryngectomy, presented to the emergency department for two weeks of syncopal episodes. He reported symptoms of lightheadedness and syncope, provoked by extension of his neck, while lying in bed.  He was admitted for investigation of a neurological versus cardiogenic cause of his symptoms.  An electroencephalogram was performed and was unremarkable. While being monitored on telemetry, the patient demonstrated the neck extension which he associated with his out of the hospital symptoms. In doing so, a 12 second pause ensued due to sinus arrest. The diagnosis of carotid sinus syndrome was confirmed.  CT angiography was performed, which showed heterogeneous soft tissue thickening with moderate narrowing of bilateral proximal internal carotid arteries likely secondary to recurrent or residual cancer.  Pursuing a conventional angiogram was discussed, but ultimately deferred, as it was not thought to significantly impact management.  The patient underwent uncomplicated placement of a leadless pacemaker, and no further pauses were appreciated on telemetry.  

Conclusions:

Carotid sinus syndrome should be considered as a differential diagnosis in patients presenting with recurrent syncope, particularly if a provoking maneuver such as neck hyperextension can be correlated.  This case demonstrates a dramatic presentation where a prolonged asystole was captured corresponding to the internal carotid compression due to laryngeal cancer.