The commonest initial symptom of nasopharyngeal cancer (NPC) is a neck mass, and the other common ones are otitis media with effusion, nasal obstruction, epistaxis, cerebral nerve palsy, and so on. Syncope is often seen in patients with head and neck tumour, but is mostly noted in cases of malignant tumour. To our knowledge, syncope as the presenting symptom of NPC is uncommon and only five cases have been reported. We report one case of nasopharyngeal cancer the initial symptom of which was recurrent syncope accompanied by strong facial pains.
A 59-year-old man complained of recurrent attacks of strong facial pains on the right side followed by syncope for about one year. He consulted a nearby doctor and was treated under the diagnosis of arrythmia. Computed tomography demonstrated multiple low density areas in the liver, which was a finding indicating a metastatic liver tumour. FDG-PET showed abnormal uptakes in the nasopharynx, bilateral upper neck and liver. Pathological study of the nasopharyngeal mucosa revealed in poorly differentiated squamous cell carcinoma. The patients was diagnosed with nasopharyngeal cancer T2bN2M1, stage IVC. Chemotherapy with cisplatin, 80mg/m2 on day 1 and 5-Fluorouracil, 400mg/m2 on days 2-5 and radiotherapy of 64Gy in 32 fractions were scheduled. FDG-PET performed about one month after treatment demonstrated no abnormal findings and the patients has been followed regularly.
The relevant literature shows that activation of the glossopharyngeal nerve (glossopharyngeal neuralgia) plays an important role in the pathophysiology of head and neck tumour-induced syncope.
Syncope as the presenting symptom of nasopharyngeal cancer is rare. In the case of syncope of unknown etiology, it is necessary to make an allowance for head and neck tumour.
