Copyright © 1993 by the European Society of Cardiology.
© 1993 The European Society of Cardiology
Parapharyngeal space lesions syncope-syndrome A newly proposed reflexogenic cardiovascular syndrome
*From the Institute and the Division of Cardiology and the Division of Neurosurgery Italy
University and Spedali Civili of Brescia Italy
**Institute of Pathology, University of Milan Italy
Received 12 October 1993; revised 25 May 1993; .
Correspondence: Dr Raoul Cicogna, Via Pendolina, 21-25100 Brescia, Italy
Abstract
An intense vaso-vagal reaction characterizes those reflex cardiovascular syncopes in which the glossopharyngeal nerve constitutes the main afferent nerve pathway. In these syndromes, afferent fibres of the glossopharyngeal nerve project from the baroreceptorial area to the medullary cardiac and vasomotor centres, from which efferent fibres descend into the vagus. The most common reflex cardiovascular syndromes linked to the IX nerve are carotid sinus syndrome (CSS) and glossopharyngeal neuralgia-asystole syndrome (GNS). Eleven male patients (mean age 65.4 years) with recurrent and severe vaso-vagal attacks are described. The episodes were characterized by asthenia and general malaise, pallor, sudation, unrecordable or very low (40–60 mmHg) arterial blood pressure, mental disorientation and/or syncope. The admission diagnosis in these patients was CSS, but the clinical picture was quite different from classic CSS: triggering factors were not present, vasovagal episodes were longer, syncopes were more frequent and severe and VVI pacing itas ineffective. Further investigation, including computerized tomography, showed in all patients a malignant or benign pathological growth occupying and compressing the parapharyngeal space. The authors think that the symptoms exhibited by their patients may be attributed to parapharyngeal space involvement. The pathogenetic mechanism of syncope in these cases could be similar to that occurring in GNS except for the absence of neuralgia itself Surgical carotid sinus denervation or A-V sequential DDD pacing were ineffective in completely controlling symptoms. Intracranial section of the IX nerve appears to be the most effective mechanism for controlling the syndrome.
The authors believe that this group of complex symptoms constitute a distinct syndrome, which by its aetiological, clinical and therapeutic aspects, differs from the otherwise classified cardiovascular syncope syndromes linked to the glossopharyngeal nerve. The denomination ‘Parapharvngeal space lesions syncope-syndrome’ is proposed.
Key Words: Carotid sinus syndrome • glossopharyngeal nerve • syncopal attacks
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