Essential Hypertension Associated with Neurovascular Compression

Abstract

According to the hypothesis of Jannetta, an arterial compression of the left root entry zone (REZ) of cranial nerves IX and X by looping arteries could play an important role in the pathogenesis of essential hypertension. In an initial anatomical study, the positions of the left vagus and glossopharyngeal nerves in the skull were radiographically determined in 10 cadavers. By using a pattern of REZ topography developed from this information, the angiographic findings in 107 hypertensive and 100 normotensive patients were then compared retrospectively. In 80% of the angiograms of the hypertensive patients that could be evaluated, an artery crossed the left REZ of cranial nerves IX and X. Most frequently, this was the posterior inferior cerebellar artery (35.3% of cases), followed by the vertebral artery (29.4% of cases) and the anterior inferior artery (19.1% of cases). In 9 cases (13%), both the posterior inferior cerebellar artery and the vertebral artery appeared in the REZ. Frequently, a larger diameter of the left vertebral artery was found. The angiograms of normotensive patients that could be evaluated revealed an artery in the REZ in only 34.5% of cases. Our results support the hypothesis that essential hypertension may be associated with neurovascular compression of the left REZ of cranial nerves IX and X.

Hypertension and Neurovascular Compression of the Left Lateral Medulla oblongata in Ischemic Stroke

“…In the current study, 71% of patients with NC on the left or both sides had hypertension, a finding similar to that reported previously [3, 9, 18]. Further research is necessary to determine whether normotensive patients with NC are more likely to develop an increased arterial pressure in the future.…”

“…Several clinical studies have indicated a causal relationship between hypertension and NC of the ventrolateral medulla on the left but not on the right side [9, 10, 11, 13, 18]. Our results also demonstrated that patients with left-side NC were more frequently hypertensive as compared with patients with NC on the right side.…”

“…In 1978, Jannetta and Gendell [5]described surgical patients with neurogenic hypertension and suggested that pulsatile compression of the ventrolateral medulla oblongata on the left side can cause arterial hypertension. After that, several other clinical reports have supported this concept [6, 7, 8, 9, 10, 11]. Furthermore, some investigators have reported that microvascular decompression of the rostral ventrolateral medulla oblongata improves or normalizes raised blood pressure [12, 13, 14, 15, 16, 17].…”

The effect of microvascular decompression of the CN IX-X root entry/exit zone and the ventrolateral medulla in neurogenic hypertension involving the vertebral/basilar artery

“…The pathogenesis of neurogenic HTN is mainly related to the overactivity of the sympathetic nervous system (5,6). Several studies have shown that neurogenic HTN usually refers to HTN caused by vascular compression of the RVLM and the REZ of the IX and X cranial nerves (7)(8)(9)(10)(11)(12). Most hypertensive patients can achieve ideal blood pressure control with systematic and regular medication.…”

Arterial compression of the retro-olivary sulcus of the medulla in essential hypertension: a multivariate analysis

“…The association between pulsatile arterial compression (AC) of the ROS and essential hypertension (EHTN) in humans has been the subject of numerous studies [13][14][15][16][17][18][19][20][21][22][23][24]. However, inconsistencies have existed in the results, as well as the exact location and laterality of arterial contact.…”