Abstract
Nasopharyngeal carcinoma (NPC) is prevalent in East and Southeast Asia, with radiotherapy being the primary treatment modality. Carotid artery stenosis is a serious but often overlooked complication of radiotherapy. We present the case of a middle-aged NPC survivor who developed progressive symptoms, including left facial numbness, dysphagia, tongue atrophy, postural dizziness, and pulsatile tinnitus, 18 years after concurrent chemoradiation. Carotid ultrasound revealed high-grade stenosis of the left cervical internal carotid artery. Following carotid stenting, his dizziness and tinnitus resolved. This case illustrates the insidious progression of carotid stenosis after radiotherapy and underscores the importance of early vascular assessment in post-radiation patients with atypical symptoms such as pulsatile tinnitus. Clinicians should maintain a high index of suspicion in at-risk individuals, and physical therapists should adopt precautionary rehabilitation strategies to minimize the risk of vascular complications.