Syncope in nasopharyngeal carcinoma: report of three cases and review of the literature.

Syncope is an uncommon symptom in patients with nasopharyngeal carcinoma (NPC). Here we report three cases of NPC with syncope. One had bilateral neck masses, invasion of the skull base, and lower cranial nerve palsies. The other two presented with neck mass only. Repeated episodes of syncope were initially controlled by intravenous atropine followed by radiotherapy and/or chemotherapy. The large primary tumor with parapharyngeal space extension and neck lymph node involvement, the invasion of the skull base and the presence of lower cranial nerve palsies are the three important risk factors for developing syncope. This is probably mainly due to the mass compression of the carotid sinus or the glossopharyngeal nerve invasion. We therefore classified these 3 cases into carotid sinus syncope type, glossopharyngeal neuralgia type and parapharyngeal space lesions type. The prognosis is poor for cases of NPC with syncope because most patients have advanced or recurrent disease, however, atropine and radiotherapy with or without chemotherapy are effective for the symptomatic treatment of syncope from locally advanced NPC.