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Case Reports in Neurological Medicine
Volume 2016 (2016), Article ID 9306784, 3 pages
http://dx.doi.org/10.1155/2016/9306784
Case Report

Carotid Space Mass Proximal to Vagus Nerve Causing Asystole and Syncope

Yale University School of Medicine, New Haven, CT 06511, USA

Received 14 May 2016; Accepted 30 June 2016

Academic Editor: Mehmet Turgut

Copyright © 2016 Julie Leviter and Daniel H. Wiznia. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Manipulation of vagal nerve rootlets, whether surgical or through mass effect of a neoplasm, can result in asystole and hypotension, accompanied by ST depression and right bundle branch block. There are few case reports of a neoplasm causing these effects, and this case describes a patient with such a mass presenting with syncopal episodes. A 43-year-old man with a past medical history of HIV, bipolar disorder, and epilepsy was admitted to the neurology service for a video electroencephalogram (vEEG) to characterize syncopal episodes that were felt to be epileptic in origin. During the study, he experienced symptoms of his typical aura, which correlated with a transient symptomatic high degree AV block on telemetry, and an absence of epileptic findings on vEEG. Magnetic Resonance Imaging (MRI) of the brain showed a mass in the left posterior carotid space at the skull base. The patient underwent permanent dual chamber MRI-compatible pacemaker placement for his heart block. His syncopal episodes resolved, but presyncopal symptoms persisted. We discuss the presentation and treatment of vagal neoplasms.