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(Stroke. 1999;30:1707-1710.)
© 1999 American Heart Association, Inc.

Case Reports

Decreases in Blood Pressure and Sympathetic Nerve Activity by Microvascular Decompression of the Rostral Ventrolateral Medulla in Essential Hypertension

Satoshi Morimoto, MD, PhD; Susumu Sasaki, MD, PhD; Kazuo Takeda, MD, PhD; Seiichi Furuya, MD, PhD; Shoji Naruse, MD, PhD; Keigo Matsumoto, MD, PhD; Toshihiro Higuchi, MD, PhD; Mitsuru Saito, PhD Masao Nakagawa, MD, PhD

From the Second Department of Medicine (S.M., S.S., K.T., M.N.), Department of Radiology (S.F., S.N.), and Department of Neurosurgery (K.M., T.H.), Kyoto Prefectural University of Medicine, Kyoto, Japan, and Laboratory of Applied Physiology, Toyota Technological Institute (M.S.), Nagoya, Japan.

Correspondence and reprint requests to Dr Satoshi Morimoto, Second Department of Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. E-mail morimot{at}koto.kpu-m.ac.jp

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.

Case Description—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.

Key Words: decompression • hypertension • sympathetic nervous system

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