Metastatic esophageal cancer presenting as shock by injury of vagus nerve mimicking baroreceptor reflex

A case report

Kenji Tsuchihashi, Tomoyasu Yoshihiro, Tomomi Aikawa, Kenta Nio, Kotoe Takayoshi, Taku Yokoyama, Mitsuhiro Fukata, Shuji Arita, hiroshi ariyama, Yukiko Shimizu, Yuichiro Yoshida, takehiro torisu, Motohiro Esaki, Keita Odashiro, Hitoshi Kusaba, Koichi Akashi, Eishi Baba

研究成果: ジャーナルへの寄稿記事

抄録

Rationale: Neurogenic shock is generally typified by spinal injury due to bone metastases in cancer patients, but continuous disturbance of the vagus nerve controlling the aortic arch baroreceptor can cause shock by a reflex response through the medulla oblongata. Patient concerns: A 43-year-old woman with dysphagia presented to our hospital. Computed tomography showed a primary tumor adjacent to and surrounding half the circumference of the descending aorta, and multiple cervical lymph node metastases, including a 55 × 35-mm lymph node overlapping the root of the left vagus nerve. Squamous esophageal cancer (T4bN3M1, stage IV) was diagnosed. Whereas shock status initially appeared soon after left cervical pain, suggesting pain-induced neutrally-mediated syncope, sustained bradycardia and hypotension occurred even after alleviation of pain by opioids. Diagnosis: Disturbance of the left vagus nerve associated with the aortic arch baroreceptor by a large left cervical lymph node metastasis was considered as the cause of shock, pathologically mimicking the baroreceptor reflex. Interventions: Systemic steroid administration was performed, and radiotherapy for both the primary site and lymph node metastasis was started 2 days after initiating steroid treatment. Outcomes: Four days after initiating steroid administration, hypotension and bradycardia were improved and stable. Lessons: Disturbance of the vagus nerve controlling the aortic arch baroreceptor should be kept in mind as a potential cause of neurogenic shock in cancer patients, through a pathological reflex mimicking the baroreceptor reflex.

元の言語英語
記事番号e8987
ジャーナルMedicine (United States)
96
発行部数49
DOI
出版物ステータス出版済み - 12 1 2017

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Vagus Nerve Injuries
Baroreflex
Esophageal Neoplasms
Vagus Nerve
Shock
Thoracic Aorta
Pressoreceptors
Lymph Nodes
Neoplasm Metastasis
Steroids
Bradycardia
Hypotension
Reflex
Pain
Spinal Injuries
Neoplasms
Medulla Oblongata
Neck Pain
Syncope
Deglutition Disorders

All Science Journal Classification (ASJC) codes

  • Medicine(all)

これを引用

Metastatic esophageal cancer presenting as shock by injury of vagus nerve mimicking baroreceptor reflex : A case report. / Tsuchihashi, Kenji; Yoshihiro, Tomoyasu; Aikawa, Tomomi; Nio, Kenta; Takayoshi, Kotoe; Yokoyama, Taku; Fukata, Mitsuhiro; Arita, Shuji; ariyama, hiroshi; Shimizu, Yukiko; Yoshida, Yuichiro; torisu, takehiro; Esaki, Motohiro; Odashiro, Keita; Kusaba, Hitoshi; Akashi, Koichi; Baba, Eishi.

:: Medicine (United States), 巻 96, 番号 49, e8987, 01.12.2017.

研究成果: ジャーナルへの寄稿記事

Tsuchihashi, Kenji ; Yoshihiro, Tomoyasu ; Aikawa, Tomomi ; Nio, Kenta ; Takayoshi, Kotoe ; Yokoyama, Taku ; Fukata, Mitsuhiro ; Arita, Shuji ; ariyama, hiroshi ; Shimizu, Yukiko ; Yoshida, Yuichiro ; torisu, takehiro ; Esaki, Motohiro ; Odashiro, Keita ; Kusaba, Hitoshi ; Akashi, Koichi ; Baba, Eishi. / Metastatic esophageal cancer presenting as shock by injury of vagus nerve mimicking baroreceptor reflex : A case report. :: Medicine (United States). 2017 ; 巻 96, 番号 49.
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abstract = "Rationale: Neurogenic shock is generally typified by spinal injury due to bone metastases in cancer patients, but continuous disturbance of the vagus nerve controlling the aortic arch baroreceptor can cause shock by a reflex response through the medulla oblongata. Patient concerns: A 43-year-old woman with dysphagia presented to our hospital. Computed tomography showed a primary tumor adjacent to and surrounding half the circumference of the descending aorta, and multiple cervical lymph node metastases, including a 55 × 35-mm lymph node overlapping the root of the left vagus nerve. Squamous esophageal cancer (T4bN3M1, stage IV) was diagnosed. Whereas shock status initially appeared soon after left cervical pain, suggesting pain-induced neutrally-mediated syncope, sustained bradycardia and hypotension occurred even after alleviation of pain by opioids. Diagnosis: Disturbance of the left vagus nerve associated with the aortic arch baroreceptor by a large left cervical lymph node metastasis was considered as the cause of shock, pathologically mimicking the baroreceptor reflex. Interventions: Systemic steroid administration was performed, and radiotherapy for both the primary site and lymph node metastasis was started 2 days after initiating steroid treatment. Outcomes: Four days after initiating steroid administration, hypotension and bradycardia were improved and stable. Lessons: Disturbance of the vagus nerve controlling the aortic arch baroreceptor should be kept in mind as a potential cause of neurogenic shock in cancer patients, through a pathological reflex mimicking the baroreceptor reflex.",
author = "Kenji Tsuchihashi and Tomoyasu Yoshihiro and Tomomi Aikawa and Kenta Nio and Kotoe Takayoshi and Taku Yokoyama and Mitsuhiro Fukata and Shuji Arita and hiroshi ariyama and Yukiko Shimizu and Yuichiro Yoshida and takehiro torisu and Motohiro Esaki and Keita Odashiro and Hitoshi Kusaba and Koichi Akashi and Eishi Baba",
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T1 - Metastatic esophageal cancer presenting as shock by injury of vagus nerve mimicking baroreceptor reflex

T2 - A case report

AU - Tsuchihashi, Kenji

AU - Yoshihiro, Tomoyasu

AU - Aikawa, Tomomi

AU - Nio, Kenta

AU - Takayoshi, Kotoe

AU - Yokoyama, Taku

AU - Fukata, Mitsuhiro

AU - Arita, Shuji

AU - ariyama, hiroshi

AU - Shimizu, Yukiko

AU - Yoshida, Yuichiro

AU - torisu, takehiro

AU - Esaki, Motohiro

AU - Odashiro, Keita

AU - Kusaba, Hitoshi

AU - Akashi, Koichi

AU - Baba, Eishi

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Rationale: Neurogenic shock is generally typified by spinal injury due to bone metastases in cancer patients, but continuous disturbance of the vagus nerve controlling the aortic arch baroreceptor can cause shock by a reflex response through the medulla oblongata. Patient concerns: A 43-year-old woman with dysphagia presented to our hospital. Computed tomography showed a primary tumor adjacent to and surrounding half the circumference of the descending aorta, and multiple cervical lymph node metastases, including a 55 × 35-mm lymph node overlapping the root of the left vagus nerve. Squamous esophageal cancer (T4bN3M1, stage IV) was diagnosed. Whereas shock status initially appeared soon after left cervical pain, suggesting pain-induced neutrally-mediated syncope, sustained bradycardia and hypotension occurred even after alleviation of pain by opioids. Diagnosis: Disturbance of the left vagus nerve associated with the aortic arch baroreceptor by a large left cervical lymph node metastasis was considered as the cause of shock, pathologically mimicking the baroreceptor reflex. Interventions: Systemic steroid administration was performed, and radiotherapy for both the primary site and lymph node metastasis was started 2 days after initiating steroid treatment. Outcomes: Four days after initiating steroid administration, hypotension and bradycardia were improved and stable. Lessons: Disturbance of the vagus nerve controlling the aortic arch baroreceptor should be kept in mind as a potential cause of neurogenic shock in cancer patients, through a pathological reflex mimicking the baroreceptor reflex.

AB - Rationale: Neurogenic shock is generally typified by spinal injury due to bone metastases in cancer patients, but continuous disturbance of the vagus nerve controlling the aortic arch baroreceptor can cause shock by a reflex response through the medulla oblongata. Patient concerns: A 43-year-old woman with dysphagia presented to our hospital. Computed tomography showed a primary tumor adjacent to and surrounding half the circumference of the descending aorta, and multiple cervical lymph node metastases, including a 55 × 35-mm lymph node overlapping the root of the left vagus nerve. Squamous esophageal cancer (T4bN3M1, stage IV) was diagnosed. Whereas shock status initially appeared soon after left cervical pain, suggesting pain-induced neutrally-mediated syncope, sustained bradycardia and hypotension occurred even after alleviation of pain by opioids. Diagnosis: Disturbance of the left vagus nerve associated with the aortic arch baroreceptor by a large left cervical lymph node metastasis was considered as the cause of shock, pathologically mimicking the baroreceptor reflex. Interventions: Systemic steroid administration was performed, and radiotherapy for both the primary site and lymph node metastasis was started 2 days after initiating steroid treatment. Outcomes: Four days after initiating steroid administration, hypotension and bradycardia were improved and stable. Lessons: Disturbance of the vagus nerve controlling the aortic arch baroreceptor should be kept in mind as a potential cause of neurogenic shock in cancer patients, through a pathological reflex mimicking the baroreceptor reflex.

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