Tumor de corpo carotídeo em jovem adolescente com pré-síncope / Carotid body tumor in teenager with pre-syncope

O tumor do corpo carotídeo (TCC) é uma neoplasia rara, mas entre os paragangliomas é o mais freqüente, com incidência de 1: 1.170.000. Desenvolve-se na adventícia do vaso, próximo à bifurcação carotídea, afetando principalmente indivíduos entre a quarta e a quinta décadas de vida. É um tumor de crescimento lento, geralmente benigno e unilateral, e 10% deles são familiares. Em cerca de 5% dos casos, a lesão é bilateral, atingindo 32% se autossômica dominante. Podem ser assintomáticos até se manifestarem como uma massa cervical pulsante, de crescimento lento, indolor, na região lateral do pescoço, próximo ao ângulo da mandíbula. A TCC pode causar rouquidão e dificuldade de deglutição por compressão extrínseca e também síndrome do corpo carotídeo hipersensível (SCCHS). Esta síndrome é conseqüência da hiperestimulação dos barorreceptores, causando hipotensão postural, acompanhada de diaforese, pré-síncope ou síncope. Neste relato descrevemos uma paciente de 17 anos com TCC familiar e SCCHS, diagnosticada e tratada com sucesso, evoluindo sem seqüelas e assintomática. (AU)

Carotid body tumor (CBT) is a rare neoplasm, but among paragangliomas it is the most frequent, with an incidence of 1: 1,170,000. It develops in the adventitia of the vessel, near the carotid bifurcation, affecting mainly individuals between the fourth and fifth decades of life. It is a slow-growing tumor, usually benign and unilateral, and 10% of them are familial. In about 5% of the cases, the lesion is bilateral, reaching 32% if it is autosomal dominant. They may be asymptomatic until they manifest as a slowly growing, painless, pulsatile cervical mass in the lateral region of the neck, near the angle of the mandible. CBT can cause hoarseness and difficulty of swallowing by extrinsic compression and also hypersensitive carotid body syndrome (SCCHS). This syndrome is a consequence of hyperstimulation of the baroreceptors, causing postural hypotension, accompanied by diaphoresis, pre-syncope or syncope. In this case report we describe a 17-year-old patient with familial CBT and SCCHS, diagnosed and treated successfully, evolving without sequelae and asymptomatic. (AU)

Hallazgos electrocardiográficos y clínicos durante la prueba de inclinación (tilt test) en pacientes con sospecha diagnóstica de síncope neurocardiogénico / Electrocardiographic and clinical findings during a trial of inclination (tilt test) in patients with suspected neurocardiogenic syncope

El Tilt test es reconocido como una herramienta diagnóstica para evaluar pacientes con síncope neuromediado. No se discutido como se puede predecir el síncope de una manera sencilla en vista de que no hay descripción de parámetros precisos que permitan predecir un Tislt test positivo. Se desea con este trabajo observar los parámetros electrocardiográficos o clínicos que permitan predecir el resultado de la prueba. Se evaluaron 275 pacientes con sospecha diagnóstica de síncope neuromediado a quienes se les realizó Tilt test (enero de 2000-2006. 108 pruebas fueron positivas (39%), y con respuesta vasodepresora un 94,5%. Edad promedio fue 32 años, sexo femenino 68%; un 74% tenían un electrocardiograma (EGC) normal al inicio del tilt test y 41% presentó arritmia sinusual durante la prueba. Los cambios en el ECG más frecuentes fueron la taquicardia sinusal (19%) y ritmo de la unión (9,5%). Hubo descenso de la presión arterial sistólica (PAS), desde la fase basal hasta el final de la prueba, la PAD tuvo un incremento inicial y luego descendió, La respuesta positiva sin droga en el grupo de escolares y adolescentes fue predominante. Los hallazgos clínicos más frecuentes fueron; mareo, presíncope y síncope. Existen hallazgos clínicos y electrocardiográficos como el pre síncope y la arritmia sinusal que por su alto valor predictivo negativo, pudieran predecir una alta probabilidad de un resultado negativo del tilt test.

Tilt testing is recognized as a valuable diagnostic tool for the evaluation of patients with neuromediated syncope. To date, it is not possible to predict syncope in a simple manner in view of the fact that there is no description of precise parameters that may predict a positive tilt test. To observe electrocardiographic and clinical features that may predict the outcome of testing. For this, 275 patients with a suspected diagnosis of neurocardiogenic syncope were evaluated with a tilt-test from January 2000 to January 2006. A total of 108 test were positive (39%) and a vasodepressor response was seen in 94.5%. The mean age was 32 years (range: 7 to 92 years). Women accounted for 68%; 74% of the patients had a normal electrocardiogram at the beginning of the test and 41% developed sinus arrhymia during the test. The most common electrocardiographical changes durint the test were sinus tachycardia (19%) and junctional rhythm (9.5%). A drop in systolic blood pressure between the start and the end of the test was observed. The diastolic blood pressure showed an initial increase followed by a decrease. There were more positive responses without drugs in the group of students and adolescents. The most frequent clinical features were dizziness, presyncope and syncope. There are clinical and electrocardiographical fundings such as presyncope and sinus arrhythmia that because of their high negative predictive value, could predict a high probability of a negative tilt test result.