Skip to main content
SpringerLink
Log in

Baroreceptor denervation presenting as part of a vagal mononeuropathy

  • Case Report
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

A 48-year-old woman presented with a history of progressive cough, dysphonia, dysphagia, and postural symptoms. Subsequent neurological investigations were consistent with a bilateral vagal mononeuropathy, and neurosarcoidosis was diagnosed after scalene node biopsy. Autonomic investigations including microneurography, neurohormones, and heart rate variability demonstrated arterial and cardiopulmonary baroreflex failure. In addition, parasympathetic control of heart rate was absent and consistent with a bilateral, nonselective lesion in the proximal vagus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Eckberg DL, Sleight P.Human baroreflexles in health and disease. Oxford: Clarendon Press; 1992; 123–152.

    Google Scholar 

  2. Berne RM, Levy MN.Physiology. 2nd ed. St Louis: Mosby; 1988; 517–523.

    Google Scholar 

  3. Mancia G, Grassi G, Ferrari A, Zanchetti A. Reflex cardiovascular regulation in humans.J Cardiovasc Pharmacol 1985; 7(suppl 3): 152–159.

    PubMed  Google Scholar 

  4. Sanders JS, Mark AL, Ferguson DW. Importance of aortic baroreflex in regulation of sympathetic responses during hypotension.Circulation 1989; 79:83–92.

    PubMed  Google Scholar 

  5. Sanders JS, Ferguson DW, Mark AL. Arterial baroreflex control of sympathetic nerve activity during elevation of blood pressure in normal man: dominance of aortic baroreflexes.Cirulation 1988; 77(pt 2):279–288.

    Google Scholar 

  6. Manger WM. Baroreflex failure — a diagnostic challenge.N Eng J Med 1993; 329:1494–1495.

    Article  Google Scholar 

  7. Robertson D, Hollister AS, Biaggioni I, Netterville JL, Mosqueda-Garcia R, Robertson RM. The diagnosis and treatment of baroreflex failure.N Eng J Med 1993; 329:1449–1455.

    Article  Google Scholar 

  8. Fitzpatrick AP, Theodorakis G, Vardas P, Sutton R. Methodology of head-up tilt testing in patients with unexplained syncope.J Am Coll Cardiol 1991; 17:125–130.

    PubMed  Google Scholar 

  9. Hollister AS. Orthostatic hypotension-causes evaluation and management.West J Med 1992; 157:652–657.

    PubMed  Google Scholar 

  10. Eckberg DL. Parasympathetic cardiovascular control in human disease: a critical review of methods and results.Am J Physiol 1980; 239:H581-H593.

    PubMed  Google Scholar 

  11. McLoed JG, Tuck RR. Disorders of the autonomic nervous system, part 2: investigation and treatment.Ann Neurol 1987; 21: 519–529.

    Article  PubMed  Google Scholar 

  12. Eisenhofer G, Goldstein DS, Stull R, Keiser HR, Sunderland T, Murphy D,et al. Simultaneous liquid chromatographic determination of 3,4-dihydrophenyl-glycol, catecholamines and 3,4-dihydroxyphenylalanine in plasma and their responses to inhibition of monoamine oxidase.Clin Chem 1986; 32:2030–2033.

    PubMed  Google Scholar 

  13. Dunn PJ, Espiner EA. Outpatient screening tests for primary aldosteronism.Aust N Z J Med 1976; 6:131–135.

    PubMed  Google Scholar 

  14. Sadler WA, Lynskey CP, Gilchrist NL, Espiner EA, Nicholls MG. A sensitive radioimmunoassay for measuring plasma anti-diuretic hormone in man.N Z J Med 1976; 83:399–401.

    Google Scholar 

  15. Jardine DL, Melton IC, Crozier IG, Bennett SI, Donald RA, Ikram H. The neurohormonal response to head-up tilt and its role in vasovagal syncope.Am J Cardiol 1997; 79:1302–1306.

    Article  PubMed  Google Scholar 

  16. Valbo AB, Hagbarth KE, Torebjork HE, Wallin BG. Somatosensory, proprioceptive and sympathetic activity in human peripheral nerves.Physiol Rev 1979; 59:919–957.

    PubMed  Google Scholar 

  17. Fagius J, Wallin G. Microneurographic evidence of excessive sympathetic outflow in the Guillain-Barre syndrome.Brain 1983; 106:589–600.

    PubMed  Google Scholar 

  18. Task Force of the European Society for Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use.Circulation 1996; 93:1043–1065.

    Google Scholar 

  19. Maran AGD. Vocal cord paralysis. In:Diseases of the nose, throat and ear. 9th ed. Birrell JF, ed. Bristol; Wright PSG Inc.; 1982. pp. 239–243.

    Google Scholar 

  20. Moore KL.Clinically orientated anatomy. 1st ed. Baltimore: Williams & Wilkins; 1980; 1090–1091.

    Google Scholar 

  21. Fagius J, Wallin BG, Sundlof G, Nerhed C, Englesen S. Sympathetic outflow in man after anaesthesia of the glossopharyngeal and vagus nerves.Brain 1985; 108:423–438.

    PubMed  Google Scholar 

  22. Kaufman H, Oribe E, Miller M, Knott P, Wiltshire-Clemment M, Yahr MD. Hypotension-induced vasopressin release distinguishes between pure autonomic failure and multiple system atrophy with autonomic failure.Neurology 1992; 42:590–593.

    PubMed  Google Scholar 

  23. Shen YT, Cowley AW, Vatner SF. Relative roles of cardiac and arterial baroreceptors in vasopressin regulation during hemorrhage in conscious dogs.Circ Res 1991; 68:1422–1436.

    PubMed  Google Scholar 

  24. Thames MD, Schmid PG, Interaction between carotid and cardiopulmonary baroreflexes in control of plasma ADH.Am J Physiol 1981; 241 (Heart Circ Physiol 10):H431-H434.

    PubMed  Google Scholar 

  25. Jordan J, Shannon JR, Black BK, Costa F, Ertl AC, Furlan R,et al. Malignant vagotonia due to selective baroreflex failure.Hypertension 1997; 30:1072–1077.

    PubMed  Google Scholar 

  26. Aksamit TR, Floras JS, Victor RG, Aylward PE. Paroxysmal hypertension due to sinoaortic baroreceptor denervation in humans.Hypertension 1987; 9:309–314.

    PubMed  Google Scholar 

  27. Fritsch JM, Smith ML, Simmons DTF, Eckberg DL. Differential baroreflex modulation of human vagal and sympathetic activity.Am J Physiol 1991; 260:R635-R641.

    PubMed  Google Scholar 

  28. Sharma OP. Neurosarcoidosis: a personal perspective based on the study of 37 patients.Chest 1997; 112(pt 2):220–228.

    PubMed  Google Scholar 

  29. Lower EE, Broderick JP, Brott TG, Baughman RP. Diagnosis and management of neurological sarcodosis.Arch Intern Med 1997; 157(pt 16):1864–1868.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology and Neurology Departments, Christchurch Hospital, Christchurch, New Zealand

    D. L. Jardine F.R.A.C.P., I. C. Melton F.R.A.C.P., S. I. Bennett N.Z.C.S., I. G. Crozier M.D., I. M. Donaldson M.D. & H. Ikram Ph.D.

Authors
  1. D. L. Jardine F.R.A.C.P.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. C. Melton F.R.A.C.P.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. I. Bennett N.Z.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. G. Crozier M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. M. Donaldson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Ikram Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. C. Melton F.R.A.C.P..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jardine, D.L., Melton, I.C., Bennett, S.I. et al. Baroreceptor denervation presenting as part of a vagal mononeuropathy. Clinical Autonomic Research 10, 69–75 (2000). https://doi.org/10.1007/BF02279894

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02279894

Key words

Search

Navigation