Portal de Periódicos da CAPES

Labile blood pressure after bilateral carotid body tumour surgery

1995; Elsevier BV; Volume: 9; Issue: 3 Linguagem: Inglês

10.1016/s1078-5884(05)80142-x

1532-2165

J.R. Boyle, N.J.M. London, Simon Tan, H. Thurston, P.R.F. Bell,

Cerebrovascular and Carotid Artery Diseases

Introduction We describe a patient with bilateral carotid body tumours that were excised on separate occasions. Following the second procedure the patient developed labile blood pressure that caused significant symptoms. Case Report A 31-year-old woman presented with bilateral neck swellings that had been present for approximately 1 year. Her main symptoms were aching pain on the right side of her neck and a feeling of something in the back of her throat. On examination, there were bilateral swellings in the anterior triangles of the neck. The swelling on the right side was larger and minimally tender. Arteriography confirmed the clin- ical impression of bilateral carotid body tumours and the right-sided tumour was excised without complica- tion. Histology confirmed the diagnosis of benign paraganglioma. Four months later she was readmitted for surgery on the left side. Preoperatively the blood pressure was stable at 110/70mmHg with a pulse of 70/rain. Immediately after excision of the second carotid body tumour the blood pressure was 120/75 mm Hg with a pulse rate of 112/min. During the next 4 days she complained of intermittent frontal headache and was noted to have a persistent sinus tachycardia of between 100 and 140/rain and a blood pressure ranging from 100/60 to 150/100 mm Hg. These symp- Please address all correspondence to: N.J.M. London, Department of Surger~ Clinical Sciences Building, Leicester Royal Infirmar~ Leicester, LE2 7LX, U.K. toms improved with simple analgesia and she was discharged home with a provisional diagnosis of bilateral damage to the carotid sinus sympathetic afferent nerves. She was also noted to have a left hypoglossal nerve neuropraxis which resolved by 2 weeks. When the patient returned to clinic 1 month later she had experienced a number of problems. She complained of palpitations, flushing and recurrent severe frontal headaches. On three occasions the headaches had been followed by loss of consciousness for a few minutes and resulted in her being rushed to her local Accident and Emergency department where she was found to be markedly hypertensive. On examination in clinic she had an erythematous rash over her upper trunk, a pulse rate of 84/rain and a blood pressure of 160/100mmHg. At this stage ambulatory blood pressure monitoring and 24 h uri- nary collections for catecholamines to exclude the possibility of a phaeochromocytoma were arranged. On arrival in clinic 3 weeks later she complained of a severe frontal headache and promptly fainted. Her blood pressure at the time was recorded as 210/128mmHg. She was therefore admitted for fur- ther investigation. The 24h urinary collections showed no excess catecholamines. The ambulatory blood pressure monitoring demonstrated considerable variations in both blood pressure and pulse rate during a 24h period (Fig. 1). Discussion Arterial blood pressure is controlled by several inter- related systems. Baroreceptors are nerve endings that lie in the walls of arteries and are stimulated when 1078-5884/95/030346 + 03 $08.00/0 © 1995 W. B. Saunders Company Ltd.