Munchausen's Syndrome Presenting as Baroreflex Failure

To the Editor: Baroreflex failure is characterized by episodes of severe hypertension and tachycardia,¹ alternating with episodes of normal or even low blood pressure and bradycardia.² It is often caused by interruption of the baroreflex arch as a result of bilateral damage to the glossopharyngeal and vagus nerves from trauma, radiation, or surgery. Less often, the lesion is in the brain stem,³ and in some cases, the primary cause is not found.A 68-year-old woman was referred for evaluation of baroreflex failure because of a four-year history of severe episodes of hypertension (systolic blood pressure >200 mm Hg for two . . .