Afferent Baroreflex Failure Following Neck Radiation: A Case Report

Afferent baroreflex failure is a rare but serious complication of neck irradiation that causes extreme blood pressure variability. We present the case of a 72 year old man with oropharyngeal cancer treated with chemotherapy and neck radiation who developed severe blood pressure lability several years after therapy. After a thorough workup ruled out other possible causes, a clinical diagnosis of afferent baroreflex failure was made, despite the absence of formal autonomic testing. Management included long acting central sympatholytics together with as needed medications to treat both hypotensive and hypertensive episodes. This case demonstrates a physiology based treatment strategy as outlined by the Vanderbilt Autonomic Dysfunction Center in the absence of formal guidelines.