Paroxismal hypertensive episodes caused by direct massage of the carotid artery by a Doppler ultrasound of the neck in a laryngectomee.

Paroxysmal hypertension can occur after radiation to the head and neck. Patients exhibit sudden elevation of blood pressure (> 200/110 mm Hg) associated with an abrupt onset of headache, chest pain, dizziness, nausea, palpitations, flushing, and sweating.

A recent case report in Journal of Medical Ultrasound describes a laryngectomee who experienced repeated paroxysmal hypertensive episodes following direct massage of the carotid artery during Doppler ultrasound of the neck. This test is often performed to detect carotid artery stenosis in head and neck cancer patients who received radiation of the neck. 

The radiation damage to the carotid artery baroreceptors might have increased their hypersensitivity to the mechanical and ultrasonic stimulation during the diagnostic test, leading to the hypertensive episodes. It is recommended that patients who had received radiation therapy for head and neck cancer and require Doppler ultrasound of the carotid artery should be monitored for paroxysmal hypertension by recording their blood pressure prior and after the test.