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Age and Ageing Advance Access originally published online on June 12, 2008
Age and Ageing 2008 37(5):602-604; doi:10.1093/ageing/afn105
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Copyright © The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society.

Case Reports

Vagolysis

C. D. Hutchinson, D. L. Jardine and M. Hurrell

Canterbury District Health Board, Christchurch, New Zealand

Address correspondence to: C. D. Hutchinson. Tel: 0064 3 3640640; Fax: 0064 3 364 1025. Email: Christopher.Hutchinson{at}cdhb.govt.nz

Abstract

We describe the case of a 75-year-old man presenting with labile hypertension and symptomatic postural hypotension 13 months following radiotherapy for squamous cell carcinoma of his external auditory canal. Magnetic resonance image (MRI) scan demonstrated scarring and a probable recurrence of his tumour. He underwent autonomic testing, including muscle sympathetic nerve activity (MSNA), heart rate (HR) and blood pressure (BP) responses to a variety of stimuli. Results were consistent with baroreflex failure. Urinary catecholamine levels were within the high normal range. We postulate that baroreflex failure was caused by vagal and glossopharyngeal nerve damage secondary to radiotherapy and tumour recurrence. This diagnosis is rare, but should be considered with pure autonomic failure and phaeochromocytoma in the presence of labile hypertension, especially in patients with a history of radiotherapy to the neck and high-normal catecholamine levels.

Keywords: baroreflex failure, sympathetic nervous system, labile hypertension, elderly

Received 14 November 2007; accepted in revised form 31 December 2007.


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