Severe carotid artery stenosis comorbid with orthostatic hypotension after radiotherapy for nasopharyngeal carcinoma：a case report

Zhou Sizhe; Tang Weiting; Li Yanlin; You Yong

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Severe carotid artery stenosis comorbid with orthostatic hypotension after radiotherapy for nasopharyngeal carcinoma：a case report

更新时间：2026-10-27

- Severe carotid artery stenosis comorbid with orthostatic hypotension after radiotherapy for nasopharyngeal carcinoma：a case report
- Journal of Chongqing Medical University Pages: 1-6(2026)
- 作者机构：
  
  海南医科大学第二附属医院神经内科，海口 570311
- 作者简介：
- 基金信息：
- DOI：
  CLC： R747.8
- Received：2026-00-05，
  
  Revised：2026-08-11，
  
  Accepted：20 August 2026，
  
  Published：27 October 2026
- 稿件说明：
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Zhou Sizhe,Tang Weiting,Li Yanlin,et al.Severe carotid artery stenosis comorbid with orthostatic hypotension after radiotherapy for nasopharyngeal carcinoma：a case report[J].Journal of Chongqing Medical University,
DOI：

Zhou Sizhe,Tang Weiting,Li Yanlin,et al.Severe carotid artery stenosis comorbid with orthostatic hypotension after radiotherapy for nasopharyngeal carcinoma：a case report[J].Journal of Chongqing Medical University, DOI：10.13406/j.cnki.cyxb..

摘要

目的

报道1例鼻咽癌（nasopharyngeal carcinoma，NPC）放疗后发生颈动脉重度狭窄合并严重直立性低血压（orthostatic hypotension，OH）的病例，并探讨其病理生理机制。

方法

总结1例以反复头晕、直立不耐受为突出表现的NPC放疗后患者的诊疗经过及长期随访结果，通过检索相关文献，对本病例潜在的病理生理机制进行分析。

结果

本例患者因NPC颈部放疗导致放射性颈动脉狭窄（radiation-induced carotid artery stenosis，RICS）及颈动脉窦区压力感受器衰竭，单纯行左侧颈内动脉支架置入术未能缓解患者的直立不耐受。入院后确诊为OH合并低钠血症，予以静脉补钠扩容及活动前口服盐酸米多君片治疗，头晕及直立不耐受症状显著改善并顺利出院。长期随访提示患者虽仍有直立性头晕症状，但程度较前减轻，未再出现晕厥前兆。

结论

放射性动脉狭窄常与自主神经压力感受器功能衰竭协同致病，临床诊治有头颈部放疗史的脑梗死或头晕患者时，应常规行卧立位血压及脑血流动力学监测以指导综合干预。

Abstract

Objective

To report a case of severe carotid artery stenosis comorbid with profound orthostatic hypotension（OH） after radiotherapy for nasopharyngeal carcinoma（NPC），and to investigate its underlying pathophysiological mechanisms.

Methods

The diagnosis and treatment process and long-term follow-up results of a patient with recurrent dizziness and orthostatic intolerance after radiotherapy for NPC were summarized，and related articles were searched to analyze the potential pathophysiological mechanisms of this case.

Results

In this case，neck radiotherapy for NPC led to radiation-induced carotid artery stenosis （RICS） and baroreceptor failure in the carotid sinus region，and consequently，internal carotid artery stenting at the left side alone failed to alleviate orthostatic intolerance. After admission，the patient was diagnosed with OH and hyponatremia and was treated with intravenous sodium supplementation for volume expansion and oral administration of midodrine hydrochloride tablets before activity. The symptoms of dizziness and orthostatic intolerance were significantly improved，and the patient was discharged successfully. Long-term follow-up showed that although orthostatic dizziness persisted，there was a reduction in its severity，and no pre-syncope episodes occurred.

Conclusion

Radiation-induced arterial stenosis and autonomic baroreceptor failure often act synergistically to cause disease，and for the diagnosis and treatment of patients with cerebral infarction or dizziness and a history of head-and-neck radiotherapy，active supine-to-standing blood pressure monitoring and cerebral hemodynamics assessments should be performed as routine screening modalities to guide comprehensive intervention.

关键词

Keywords

references

Chen YP ， Chan ATC ， Le QT ， et al . Nasopharyngeal carcinoma [J ] . Lancet ， 2019 ， 394 （ 10192 ）： 64 - 80 ．

Chua MLK ， Zhang X ， Wong KCW ， et al . Updates on treatments and management of nasopharyngeal carcinoma [J ] . Am Soc Clin Oncol Educ Book ， 2025 ， 45 （ 3 ）： e472460 ．

Xu JP ， Cao YJ . Radiation-induced carotid artery stenosis：a comprehensive review of the literature [J ] . Interv Neurol ， 2014 ， 2 （ 4 ）： 183 - 192 ．

Azzam P ， Mroueh M ， Francis M ， et al . Radiation-induced neuropathies in head and neck cancer：prevention and treatment modalities [J ] . Ecancermedicalscience ， 2020 ， 14 ： 1133 ．

Sharabi Y ， Dendi R ， Holmes C ， et al . Baroreflex failure as a late sequela of neck irradiation [J ] . Hypertension ， 2003 ， 42 （ 1 ）： 110 - 116 ．

Abe JI ， Allen BG ， Beyer AM ， et al . Radiation-induced macrovessel/microvessel disease [J ] . ATVB ， 2024 ， 44 （ 12 ）： 2407 - 2415 ．

So PN ， Ottun AA ， Allihien SM ， et al . Radiation-induced baroreflex dysfunction：a rare case of severe orthostatic hypotension [J ] . Cureus ， 2025 ， 17 （ 10 ）： e94423 ．

Freeman R ， Wieling W ， Axelrod FB ， et al . Consensus statement on the definition of orthostatic hypotension，neurally mediated Syncope and the postural tachycardia syndrome [J ] . Clin Auton Res ， 2011 ， 21 （ 2 ）： 69 - 72 ．

Low PA ， Tomalia VA . Orthostatic hypotension：mechanisms，causes，management [J ] . J Clin Neurol ， 2015 ， 11 （ 3 ）： 220 - 226 ．

陈　睿，李姝莹，唐玮婷，等 . 以自主神经功能障碍为突出表现的鼻咽癌一例并文献复习 [J ] . 中国医师杂志， 2023 ， 25 （ 5 ）： 685 - 690 ．

Chen R ， Li SY ， Tang WT ， et al . A case of nasopharyngeal carcinoma with autonomic nervous dysfunction and literature review [J ] . J Chin Physician ， 2023 ， 25 （ 5 ）： 685 - 690 ．

Karim S ， Chahal A ， Khanji MY ， et al . Autonomic cardiovascular control in health and disease [J ] . Compr Physiology ， 2023 ， 13 （ 2 ）： 4493 - 4511 ．

Gujral DM ， Shah BN ， Chahal NS ， et al . Clinical features of radiation-induced carotid atherosclerosis [J ] . Clin Oncol ， 2014 ， 26 （ 2 ）： 94 - 102 ．

Leung HWC ， Wang SY ， Lin CL ， et al . Radiation dose-induced carotid artery stenosis and brain necrosis in head and neck cancer-a real world cohort study [J ] . Cancers ， 2024 ， 16 （ 17 ）： 2982 ．

Liang HQ ， Zhou YY ， Xiong W ， et al . Impact of radiotherapy for nasopharyngeal carcinoma on carotid stenosis risk：a meta-analysis [J ] . Braz J Otorhinolaryngol ， 2022 ， 88 （ Suppl 4 ）： S98 - S107 ．

Norcliffe-Kaufmann L ， Galindo-Mendez B ， Garcia-Guarniz AL ， et al . Transcranial Doppler in autonomic testing：standards and clinical applications [J ] . Clin Auton Res ， 2018 ， 28 （ 2 ）： 187 - 202 ．

Xu WH ， Wang H ， Wang B ， et al . Disparate cardio-cerebral vascular modulation during standing in multiple system atrophy and Parkinson disease [J ] . J Neurol Sci ， 2009 ， 276 （ 1/2 ）： 84 - 87 ．

Kaufmann H ， Norcliffe-Kaufmann L ， Palma JA . Baroreflex dysfunction [J ] . N Engl J Med ， 2020 ， 382 （ 2 ）： 163 - 178 ．

Shibao C ， Grijalva CG ， Raj SR ， et al . Orthostatic hypotension-related hospitalizations in the United States [J ] . Am J Med ， 2007 ， 120 （ 11 ）： 975 - 980 ．

Spallone V ， Bellavere F ， Scionti L ， et al . Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy [J ] . Nutr Metab Cardiovasc Dis ， 2011 ， 21 （ 1 ）： 69 - 78 ．

Clarke AJ ， Swart G ， Clifford AR ， et al . Baroreflex failure as a long-term sequela of head and neck irradiation [J ] . Journal of Neurology ， 2023 ， 270 （ 5 ）： 2784 - 2788 ．

Verbalis JG ， Goldsmith SR ， Greenberg A ， et al . Diagnosis，evaluation，and treatment of hyponatremia：expert panel recommendations [J ] . Am J Med ， 2013 ， 126 （10 Suppl 1 ）： S1 - S42 ．

Mathias CJ ， Bannister R . Autonomic Failure：A Textbook of Clinical Disorders of the Autonomic Nervous System [M ] . 5th ed . Oxford University Press ， 2013 ．

Wilkens I ， Hopfner F . Multiple system atrophy：integrating clinical phenotypes and multimodal biomarkers for early diagnosis [J ] . Front Aging Neurosci ， 2026 ， 18 ： 1801658 ．

李彦琳 . 2型糖尿病体位性脑血流动力学变化与其不良预后的相关性研究 [J ] . 中风与神经疾病杂志， 2025 ， 42 （ 11 ）： 974 - 978 . ．

Li YL . Postural cerebral hemodynamic changes in patients with type 2 diabetes mellitus and their association with adverse outcomes [J ] . J Apoplexy Nerv Dis ， 2025 ， 42 （ 11 ）： 974 - 978 .

Sarafidis PA ， Theodorakopoulou M ， Dipla K ， et al . Hyponatremia accompanying volatile hypertension caused by baroreflex failure after neck surgery：case report and literature review [J ] . J Hypertens ， 2020 ， 38 （ 8 ）： 1617 - 1624 ．

Adrogué HJ ， Madias NE . The syndrome of inappropriate antidiuresis [J ] . N Engl J Med ， 2023 ， 389 （ 16 ）： 1499 - 1509 ．

Lewis A ， Thant AA ， Aslam A ， et al . Diagnosis and management of adrenal insufficiency [J ] . Clin Med ， 2023 ， 23 （ 2 ）： 115 - 118 ．

Brignole M ， Moya A ， De Lange FJ ， et al . 2018 ESC Guidelines for the diagnosis and management of Syncope [J ] . Kardiol Pol ， 2018 ， 76 （ 8 ）： 1119 - 1198 ．

Yusufuaji Y ， Tang BP ， et al . Evaluation of the clinical value of heart rate variability in predicting vasovagal Syncope [J ] . Front Cardiovasc Med ， 2026 ， 12 ： 1684990 ．

Xu WH ， Wang H ， Hu YH ， et al . Supine-to-standing transcranial Doppler test in patients with multiple system atrophy [J ] . Park Relat Disord ， 2013 ， 19 （ 5 ）： 539 - 542 ．

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