[Coexistence of two hemodynamically significant mechanisms for syncope associated with glossopharyngeal neuralgia]. / Coexistencia de dos mecanismos hemodinámicamente significativos en el síncope asociado a neuralgia del glosofaríngeo.

Syncope is a rare presentation of glossopharyngeal neuralgia (GN). A patient with squamous cell cancer of the pharynx had GN and syncope due to asystolic pauses and extreme hypotension. The bradyarrhythmias were atropine-sensible, but both this treatment and pacing failed to prevent recurrence of syncopal hypotensive crises, blood pressure continuing to fall during GN attacks. These data suggest that during a neuralgic attack the stimulation excites vagi, causing asystole, and simultaneously abolishes sympathetic tone. Carbamazepine was effective in controlling the symptoms of the patient.

[Lipomatous hypertrophy of the interauricular septum as a cause of cerebral embolism in a patient with isolated Wernicke's aphasia]. / Hipertrofia lipomatosa del tabique interauricular como causa de embolismo cerebral en un paciente con afasia de Wernicke aislada.

The clinical observation of a 74 year old male presenting isolated Wernicke's aphasia due to a temporal left infarction of cardiac embolic origin secondary to paroxysmal auricular flutter is described. Transthoracic and transesophageal echocardiography, computerized tomography and magnetic resonance provided characteristic images which permitted the establishment of the diagnosis of lipomatous hypertrophy of the interauricular septum without requiring the use of invasive techniques. Lipomatous hypertrophy of the interauricular septum is a cardiac tumor of unusual presentation constituted of an abnormal accumulation of non-encapsulated fatty tissue which occupies a thickness greater than 15 mm of the interauricular septum. Wernicke's aphasia as a form of presentation of the lipomatous hypertrophy of the interauricular septum has not previously been described in the literature.