Fecal incontinence after pelvic radiotherapy: evidences for a lumbosacral plexopathy. Report of a case.

PURPOSE: Clinical manifestations of radiation-induced lumbosacral plexopathy remain a rare event. We report the case of a 62-year-old woman with neurogenic fecal incontinence that occurred after radiotherapy of cervical carcinoma. METHODS: Anorectal, bladder, and lower limb sensory-motor functions, as biologic and morphologic explorations, were performed on repeated occasions. RESULTS: Anorectal manometry, conduction times of pudendal nerves, sacral latencies, and pudendal nerve-evoked corticals disclosed lesions of the lumbosacral plexus that was confirmed by bladder manometry and electromyography of lower limbs. Biologic and morphologic explorations were within normal ranges. CONCLUSION: Because no other cause except radiation was demonstrated in this case, we suggest that plexopathy may be a late-occurring complication of radiotherapy.

Hypertensive encephalopathy after bilateral carotid endarterectomy.

BACKGROUND: Hypertension occurs frequently after carotid endarterectomy and may lead to cerebral vascular complications and myocardial infarction. Its pathophysiology has recently been related to surgically induced damage of carotid baroreceptors. CASE DESCRIPTION: A 45-year-old normotensive man with no history of epilepsy was admitted 3 weeks after bilateral carotid endarterectomy for severe repetitive paroxysmal headaches, vomiting, and agitation that were closely associated with attacks of marked hypertension. During one of these attacks, he had a grand mal seizure. Plasma catecholamine levels during hypertensive attacks were highly elevated despite the absence of pheochromocytoma, reflecting abnormalities in baroreceptor sensitivity that lead to unrestrained activation of the central sympathetic nervous system. Heart rate response to Valsalva maneuver showed suppression of the usual tachycardia, indicating baroreceptor reflex insensitivity. CONCLUSIONS: We report the first case of hypertensive encephalopathy associated with baroreflex failure syndrome after bilateral carotid endarterectomy. The role of blood pressure monitoring may be critical in revealing carotid baroreceptor insensitivity in such clinical settings.