Radiation-induced cranial neuropathies manifesting as baroreflex failure and progressive bulbar impairment

Baroreflex failure and bulbar palsy have been rarely reported as potential complications of radiotherapy for head and neck tumors. However, the occurrence of both disorders in the same patient has not been well described. We present a unique patient with radiation-induced cranial neuropathies, resulting in bulbar palsy and baroreflex failure.

A 67-year-old man underwent surgical resection of tonsillar squamous cell carcinoma and postoperative radiation therapy. Six years later, he developed severe orthostatic hypotension with syncope, followed later by progressive bulbar impairment. EMG showed myokymic discharges in the tongue, and marked orthostatic hypotension was noted on tilt-table testing.

Progressive bulbar impairment and baroreflex failure can occur following radiotherapy for head and neck cancers. Furthermore, these manifestations of radiation injury can occur in the same patient.