Document Detail

Arterial hypertension and neurovascular compression at the ventrolateral medulla. A comparative microanatomical and pathological study.
MedLine Citation:
PMID:  1307855     Owner:  NLM     Status:  MEDLINE    
Intraoperative observations and animal experiments suggest that neurovascular compression at the left ventrolateral medulla is a possible etiological factor in essential hypertension. In pursuing this hypothesis, the authors examined the neurovascular relations in the posterior cranial fossa of 24 patients with essential hypertension, of 10 with renal hypertension, and of 21 normotensive control patients. Artificial perfusion of the vessels and microsurgical investigations during autopsy identified the vascular relations at the brain stem and at the root entry zone of the caudal cranial nerves. There was no evidence of neurovascular compression at the ventrolateral medulla on the left side in any patient from the control group or among those with renal hypertension. Two normotensive patients had neurovascular compression at the right ventrolateral medulla by the posterior inferior cerebellar artery. In contrast, all patients with essential hypertension had definite neurovascular compression at the left ventrolateral medulla. Additional compression of the right side was seen in three of these patients. Based on the anatomical appearance, it was possible to define three distinct types of neurovascular compression at the ventrolateral medulla. Common to all three types is the compression of the medulla oblongata at its rostral part just caudal to the pontomedullary junction and lateral to the olive in the retro-olivary sulcus. Comparative histopathological study of the microsurgically examined brain-stem specimens revealed no differences between patients with essential hypertension, those with renal hypertension, and normal controls. There was a structural integrity at the site of neurovascular compression at the ventrolateral medulla. The microanatomical findings of this study show that neurovascular relations at the ventrolateral medulla in essential hypertension give rise to pulsatile compression on the left. This supports Jannetta's hypothesis of neurovascular compression at the left ventrolateral medulla as an etiology of essential hypertension.
R Naraghi; M R Gaab; G F Walter; B Kleineberg
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  77     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  1992 Jul 
Date Detail:
Created Date:  1992-07-20     Completed Date:  1992-07-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  103-12     Citation Subset:  AIM; IM    
Department of Neurological Surgery, Hannover Medical School, Germany.
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MeSH Terms
Aged, 80 and over
Arteries / pathology
Brain / blood supply
Constriction, Pathologic
Cranial Nerves / pathology
Hypertension / etiology*,  pathology,  physiopathology
Medulla Oblongata / pathology*,  physiopathology,  ultrastructure
Middle Aged
Nerve Compression Syndromes / complications*,  pathology,  physiopathology
Comment In:
J Neurosurg. 1992 Jul;77(1):101-2   [PMID:  1607951 ]
J Neurosurg. 1995 Nov;83(5):943-4   [PMID:  7472575 ]
J Neurosurg. 1993 Feb;78(2):310-2   [PMID:  8421217 ]

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