[Neurovascular compression of the medulla oblongata: a rare cause of secondary hypertension].
Compression of the rostral ventrolateral medulla oblongata is one of the rarely identified causes of refractory hypertension. In patients with severe, intractable hypertension caused by neurovascular compression, neurosurgical decompression should be considered. The authors present the history of a 20-year-old man with severe hypertension. After excluding other possible causes of secondary hypertension, the underlying cause of his high blood pressure was identified by the demonstration of neurovascular compression shown by magnetic resonance angiography and an increased sympathetic activity (sinus tachycardia) during the high blood pressure episodes. Due to frequent episodes of hypertensive crises, surgical decompression was recommended, which was performed with the placement of an isograft between the brainstem and the left vertebral artery. In the first six months after the operation, the patient's blood pressure could be kept in the normal range with significantly reduced doses of antihypertensive medication. Repeat magnetic resonance angiography confirmed the cessation of brainstem compression. After six months, increased blood pressure returned periodically, but to a smaller extent and less frequently. Based on the result of magnetic resonance angiography performed 22 months after surgery, re-operation was considered. According to previous literature data long-term success can only be achieved in one third of patients after surgical decompression. In the majority of patients surgery results in a significant decrease of blood pressure, an increased efficiency of antihypertensive therapy as well as a decrease in the frequency of highly increased blood pressure episodes. Thus, a significant improvement of the patient's quality of life can be achieved. The case of this patient is an example of the latter scenario.
Bajcsy-Zsilinszky Kórház III. Belgyógyászati Oktató Osztály Budapest Maglódi út 89-91. 1106.
Judit
J
Nádas
Országos Idegtudományi Intézet Budapest.
Sándor
S
Czirják
Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest.
Péter
P
Igaz
Szegedi Tudományegyetem, Általános Orvostudományi Kar Radiológiai Klinika Szeged.
Erika
E
Vörös
Bajcsy-Zsilinszky Kórház III. Belgyógyászati Oktató Osztály Budapest Maglódi út 89-91. 1106.
György
G
Jermendy
Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest.
Károly
K
Rácz
Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest.
Miklós
M
Tóth
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis; D019299:Decompression, Surgical / Q000379:methods; D006728:Hormones / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology* / Q000503:physiopathology*; D013610:Tachycardia / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
D000959:Antihypertensive Agents; D015415:Biomarkers; D006728:Hormones
dekompressziós műtét; neurovascular compression; neurovascularis kompresszió; secondary hypertension; surgical decompression; szekunder hypertonia