title: Long-lasting improvement of arterial hypertension after surgical treatment of a foramen magnum meningioma: case report.
abstract: BACKGROUND
  Neurogenic arterial hypertension has been proposed to be caused by neurovascular compression in many cases. However, there is little reference to tumors causing hypertension by local compression of the vagal nerve or the ventrolateral medulla oblongata. The following case illustrates the effects of surgery for a meningioma of the foramen magnum on arterial hypertension.
  
  
  METHODS
  A 54-year-old woman suffered from arterial hypertension for at least 7 months, for which she required a combined medical treatment regime. She suffered for 6 months from dizziness and tinnitus, more in the left ear than in the right. Neurologic examination revealed a horizontal fixation nystagmus and a mild left-sided hearing loss. Magnetic resonance imaging and computed tomographic angiography showed a contrast-enhancing tumor on the left side of the foramen magnum compressing the medulla oblongata close to the vertebral artery and vascularized by branches of the left PICA. Complete surgical extirpation was performed using a medial craniocervical approach. The tinnitus and dizziness were gone and hearing improved. Postoperatively, the arterial hypertension showed a long-lasting improvement (observation period 8 months) with only minimal medical treatment.
  
  
  CONCLUSIONS
  Based on our case, we conclude that tumors in close proximity to the ventrolateral medulla oblongata may induce neurogenic hypertension, similar to neurovascular compression.
authors.affiliation: Neurosurgical Department, Klinikum Villingen-Schwenningen, Germany.
authors.forename: Bertold Andreas
authors.initials: BA
authors.lastname: Wörner
authors.forename: Tamim
authors.initials: T
authors.lastname: Rahim
authors.forename: Manfred
authors.initials: M
authors.lastname: Lange
authors.forename: Ulrich
authors.initials: U
authors.lastname: Fink
authors.forename: Reinhard
authors.initials: R
authors.lastname: Oeckler
mesh_terms: D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D005539:Foramen Magnum / Q000473:pathology / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008526:Medulla Oblongata / Q000473:pathology / Q000601:surgery; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D020421:Vagus Nerve Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery