Decreases in blood pressure and sympathetic nerve activity by microvascular decompression of the rostral ventrolateral medulla in essential hypertension.
BACKGROUND
Neurovascular compression of the rostral ventrolateral medulla, a major center regulating sympathetic nerve activity, may be causally related to essential hypertension. Microvascular decompression of the rostral ventrolateral medulla decreases elevated blood pressure.


METHODS
A 47-year-old male essential hypertension patient with hemifacial nerve spasms exhibited neurovascular compression of the rostral ventrolateral medulla and facial nerve. Microvascular decompression of the rostral ventrolateral medulla successfully reduced blood pressure and plasma and urine norepinephrine levels, low-frequency to high-frequency ratio obtained by power spectral analysis, and muscle sympathetic nerve activity.


CONCLUSIONS
This case suggests not only that reduction in blood pressure by microvascular decompression of the rostral ventrolateral medulla may be mediated by a decrease in sympathetic nerve activity but also that neurovascular compression of this area may be a cause of blood pressure elevation via increased sympathetic nerve activity.
Morimoto
S
S
Second Department of Medicine Kyoto Prefectural University of Medicine, Kyoto, Japan. morimot@koto.kpu-m.ac.jp
Sasaki
S
S
Takeda
K
K
Furuya
S
S
Naruse
S
S
Matsumoto
K
K
Higuchi
T
T
Saito
M
M
Nakagawa
M
M
D001794:Blood Pressure / Q000502:physiology*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply*; D008833:Microcirculation; D008875:Middle Aged; D013564:Sympathetic Nervous System / Q000098:blood supply / Q000503:physiopathology*