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(Stroke. 1997;28:1749-1754.)
© 1997 American Heart Association, Inc.

Articles

Neurovascular Compression at the Ventrolateral Medulla in Autosomal Dominant Hypertension and Brachydactyly

Ramin Naraghi, MD; Herbert Schuster, MD; Hakan R. Toka, MS; Sylvia Bähring, PhD; Okan Toka, MS; Özgür Öztekin, MD; Nihat Bilginturan, MD; Hans Knoblauch, MD; Thomas F. Wienker, MD; Andreas Busjahn, PhD; Hermann Haller, MD; Rudolf Fahlbusch, MD; Friedrich C. Luft, MD, FACP, FRCP(Edin)

From the Franz Volhard Clinic (H.S., H.R.T., S.B., O.T., H.K., T.F.W., A.B., H.H., F.C.L.) and Max Delbrück Center for Molecular Medicine, Virchow Klinikum, Humboldt University of Berlin (Germany); Department of Neurosurgery (R.M., R.F.), Friedrich Alexander University of Erlangen-Nürnberg (Germany); and Department of Pediatrics (N.B., Ö.Ö.), Hacettepe University, Ankara, Turkey.

Correspondence to Friedrich C. Luft, Franz Volhard Clinic, Wiltberg Strasse 50, 13122 Berlin, Germany. E-mail fcluft{at}orion.rz.mdc-berlin.de

Background and Purpose Autosomal dominant hypertension with brachydactyly features severe hypertension that causes stroke usually before the age of 50 years. We recently characterized the hypertension as featuring normal renin, aldosterone, and catecholamine responses and mapped the gene responsible to chromosome 12p. Since angiography in an affected subject had earlier shown tortuous vessels, we performed magnetic resonance tomography (MRT) angiography to look for possible neurovascular anomalies (NVA), which have been previously associated with hypertension. NVA can be caused by a looping posterior inferior cerebellar or vertebral artery. Experimental and clinical evidence suggests that NVA may cause hypertension by a compression of the ventrolateral medulla.

Methods We performed MRT in 15 hypertensive affected (aged 14 to 57 years) and 12 normotensive nonaffected (aged 12 to 59 years) family members. We then tested for linkage between the hypertension-brachydactyly phenotypes and the presence of NVA.

Results All 15 affected persons had MRT evidence for NVA. All had left-sided posterior inferior cerebellar artery or vertebral artery loops, while 6 had bilateral NVA. None of the nonaffected family members had NVA. The phenotypes were linked with an LOD score of 9.2 given a penetrance of 99%.

Conclusions Autosomal dominant hypertension and brachydactyly regularly feature NVA, which is frequently bilateral. The early age at which NVA was identified suggests that the condition is primary. We suggest that NVA may be involved in the pathogenesis of this form of hypertension and perhaps essential hypertension as well. Further studies are necessary to address the question of causation.

Key Words: cerebral arteries • genetics • hypertension • vertebral artery • young adults

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