Convulsive syncope as presenting symptom of carotid body tumors: Case series
A 65-year-old woman has referred to Al-Zahra Hospital, Isfahan, Iran, in September 2011, because of recurrent episodes of loss of consciousness since 10 months ago, the first one occurred when she was standing for a long time; her relatives described this attack as a fit of falling, loss of consciousness, and tonic movements that took 1-2 min; she was treated with antiepileptic drugs, but her attacks continued and repeated more and more. She has been treated as a case of intractable epilepsy. Her attacks began with the rotation of neck as focal seizure, too.\nDrug history was negative except for phenytoin and carbamazepin that started from 10 months ago. The neurological examination was normal but in the general examination during carotid auscultation suddenly the patient became pale and impaired her consciousness as well as, adversive head movement and then tonic movement of limbs. This event continued for 1-2 min and then she became conscious. Gentle examination revealed painless, oval shape, mobile, 2 cm × 3 cm mass in the right mandibular ankle.\nCervical magnetic resonance imaging (MRA) and computed tomography (CT) angiography showed separation between the right internal and external carotid arteries on left-side []. Cervical Doppler color sonogeraphy showed soft-tissue, hypo echo mass at carotid bifurcation. Electrocardiography (ECG), echocardiography and exercise test were in normal category. The patient was referred to the vascular surgeon and excision of CBT and lymphadenectomy was done. Report of pathology confirmed carotid body of three rather firm, tan colored tissue fragments measuring 5.5 cm × 5.2 cm that on section were solid with homogenous features.\nAfter surgery, the patient did not experience another attack of syncope and anticonvulsive drugs discontinued.