Hypertension in patients with cranial nerve vascular compression syndromes and comparison with a population-based cohort

Abstract

Object. Although essential arterial hypertension (AH) represents a major health issue, its underlying causes remain unknown. An intriguing hypothesis is that AH in some cases may be caused by vascular compression of the rostral ventrolateral medulla (RVLM). Because hemifacial spasms (HFSs) are caused by vascular compression of the seventh cranial nerve in close proximity to the RVLM, one would, if this hypothesis is correct, expect to find a positive association between the occurrence of AH and chronic HFSs. Such a positive association would not be expected in patients with trigeminal neuralgia (TN), since TN is caused by vascular compression of the fifth cranial nerve, which is not close to the RVLM.Methods. In view of this background, the authors conducted a retrospective population-based study to investigate how the occurrence of AH in patients with either HFSs or TN compares with the prevalence of AH in the general population, when adjusted for sex and age. The general population was represented by participants of the NordTrøndelag Health Study 3 (HUNT3).Results. The prevalence of AH in the authors' patients with HFSs was significantly higher than in a sex-and age-adjusted sample from the general population; this was not true for the patients with TN.Conclusions. The authors suggest that the data provide supporting evidence to the theory that compression of the RVLM may be one cause of AH. (http://thejns.org/doi/abs/10.3171/2013.7.JNS13231) Key WordS • arterial hypertension • essential hypertension • hemifacial spasm • trigeminal neuralgiaAbbreviations used in this paper: AH = arterial hypertension; CI = confidence interval; HFS = hemifacial spasm; HUNT3 = Nord-Trøndelag Health Study 3; MRA = MR angiography; MVD = microvascular decompression; NC = neurovascular compression; OR = odds ratio; RVLM = rostral ventrolateral medulla; TN = trigeminal neuralgia.

Revisiting the link between hypertension and hemifacial spasm

“…In addition, all studies 4 5 6 7 8 9 found a correlation between the prevalence of arterial hypertension in cases and the presence of neurovascular compression. 3 out of 6 found that this was more so in patients with left-sided symptoms while the other 3 studies did not specifically differentiate left- and right-sided disease.…”

“…A total of 549 HFS cases and 720 neurological controls contributed to the meta-analysis. Sandell et al 4 used the general population as the control group via data from 50316 participants in the Nord-Trondelag Health Study 3 (HUNT3). The background information of the participants is presented in Table 1 .…”

“…The 6 studies 4 5 6 7 8 9 we have chosen for our meta-analysis have inherent differences that must be considered. These include: Study subjects of different ethnicities Definition of hypertension Inclusion Criteria of the study …”

Microvascular decompression in patients with hemifacial spasm

“…Some of these patients with refractory hypertension can have concurrent HFS (Leong, Li, Chan, & Tan, ). Their hypertension may be due to neurogenic causes from increased sympathetic activities from the vascular compression at the left rostral ventrolateral medulla (RVLM) and REZ of cranial nerve IX, X (Jannetta & Gendell, ; Naraghi et al, ; Sandell, Holmen, & Eide, ; Solar, Ceral, Zizka, & Elias, ). Studies have shown that MVD surgery could improve the clinical symptoms of HFS and, at the same time, could also decrease the blood pressure in patients with refractory hypertension (Barley & Ellis, ; Sindou, Mahmoudi, & Brinzeu, ).…”

“…Some of these patients with refractory hypertension can have concurrent HFS (Leong, Li, Chan, & Tan, 2016). Their hypertension may be due to neurogenic causes from increased sympathetic activities from the vascular compression at the left rostral ventrolateral medulla (RVLM) and REZ of cranial nerve IX, X (Jannetta & Gendell, 1979;Naraghi et al, 1994;Sandell, Holmen, & Eide, 2013;Solar, Ceral, Zizka, & Elias, 2009).…”