Baroreflex failure syndrome: a rare complication of bilateral carotid body tumor excision

Baroreflex failure syndrome is a rare disorder seen after bilateral carotid body tumor resection. Iatrogenic injuries to the baroreceptor reflex arc cause fluctuations in blood pressure with hypertensive attacks or hypotensive episodes. A 43-year-old woman underwent bilateral carotid body tumor resection with one-week interval for a hypervascular tumor, 78 x 50 x 45 mm in size, at the right carotid artery bifurcation and a smaller tumor (50 x 30 x 20 mm) in the contralateral neck. Blood pressure of the patient became significantly unstable after excision of the second tumor, with hypertensive attacks up to 220/140 mmHg, accompanied by episodes of severe frontal headache, nausea, vomiting, skin flushing, and synchronous sinus tachycardia of 130 beats/min. Intermittent episodes of hypotension and bradycardia were also noted. The patient was clinically diagnosed as having baroreflex failure syndrome. The symptoms of the patient improved with medical therapy including clonidine, low dose beta-blocker, metoprolol, and a sedative. During 10 months of follow-up, she was generally well with residual episodes of hypertension about twice a month. In patients with bilateral carotid body tumors, unilateral excision of the greater tumor and a conservative approach for the contralateral tumor seem to be a more convenient approach to prevent baroreflex failure.