Complete Resolution of Hypertension after Decompression of Chiari I Malformation

Erik C. Parker; Charles Teo; Salim Rahman; Michael C. Brodsky

doi:10.1055/s-2000-9511

Skull Base Surgery, Table of Contents

Skull Base 2000; Volume 10(Number 03): 149-152
DOI: 10.1055/s-2000-9511

Complete Resolution of Hypertension after Decompression of Chiari I Malformation

Erik C. Parker, Charles Teo, Salim Rahman, Michael C. Brodsky

Department of Neurosurgery, New York University, New York, New York (ECP); Department of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas (CT); Department of Neurosurgery (SR) and Department of Ophthalmology (MCB), University of Arkansas for Medical Sciences, Little Rock, Arkansas

Abstract

ABSTRACT

The Chiari I malformation has not been previously linked to sustained hypertension. Other forms of medullary compression have, however, been shown to be associated with elevated arterial pressure. This association has been demonstrated through numerous studies that have implicated compression of the rostral ventrolateral medulla, usually by vascular structures, as a factor responsible for hypertension. We present a case of a young man with a 2-year history of hypertension who was found to have a Chiari I malformation. No other cause for hypertension was found. After subsequent surgical decompression, his hypertension resolved immediately. No other therapeutic options were activated. This is the first reported case linking Chiari I malformation and sustained hypertension. This case presents further evidence linking medullary compression and elevation of hemodynamic tone.

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References

REFERENCES

1 Paul K S, Lye R H, Strang F A, Dutton J. Arnold-Chiari malformation. J Neurosurg . 1983; 58 183-188
2 Arcaya J, Cacho J, Del Campo F, Grande J, Maillo A. Arnold-Chiari malformation associated with sleep apnea and central dysregulation of arterial pressure. Acta Neurol Scand . 1993; 88 224-226
3 Dickinson L D, Papadopoulos S M, Hoff J T. Neurogenic hypertension related to basilar impression: Case report. J Neurosurg . 1993; 79 924-928
4 Fein J M, Frishman W. Neurogenic hypertension related to vascular compression of the lateral medulla. Neurosurgery . 1980; 6 615-622
5 Jannetta P J, Segal R, Wolfson S K. Neurogenic hypertension: Etiology and surgical treatment. I. Observation in 53 patients. Ann Surg . 1985; 201 391-398
6 Kleineberg B, Becker H, Gaab M R. Neurovascular compression and essential hypertension. Neuroradiology . 1991; 33 2-8
7 Naraghi R, Gaab M R, Walter G F, Kleineberg B. Arterial hypertension and neurovascular compression at the ventrolateral medulla. J Neurosurg . 1992; 77 103-112
8 Jannetta P J, Segal R, Wolfson S K, Dujovny M, Semba A, Cook E E. Neurogenic hypertension: Etiology and surgical treatment. II. Observations in an experimental nonhuman primate model. Ann Surg . 1985; 202 253-261
9 Segal R, Gendell H M, Canfield D, Dujovny M, Jannetta P J. Hemodynamic changes induced by pulsatile compression of the ventrolateral medulla. Angiology . 1982; 33 161-172
10 Blessing W W, Reis D J. Inhibitory cardiovascular function of neurons in the caudal ventrolateral medulla of the rabbit: Relationship to the area containing A1 nonadrenergic cells. Brain Res . 1982; 253 161-171
11 Caverson M M, Ciriello J, Calaresu F R. Direct pathway from cardiovascular neurons in the ventrolateral medulla to the region of the intermediolateral nucleus of the upper thoracic cord: An anatomical and electrophysiological investigation in the cat. J Auton Nerv Syst . 1983; 9 451-475
12 Ciriello J, Caverson M M. Bidirectional cardiovascular connections between ventrolateral medulla and nucleus of solitary tract. Brain Res . 1986; 367 273-281
13 Ciriello J, Caverson M M, Polosa C. Function of the ventrolateral medulla in the control of the circulation. Brain Res Rev . 1986; 11 359-391
14 Dampney R AL, Goodchild A K, Robertson L G, Montgomery W. Role of ventrolateral medulla in vasomotor regulation: A correlative anatomical and physiological study. Brain Res . 1982; 249 223-235
15 Dormer K J, Bedford T G. Cardiovascular control by the rostral ventrolateral medulla in the conscious dog. Prog Brain Res . 1989; 81 265-277
16 Ross C A, Ruggiero D A, Park D H, Joh T H, Sved A F, Fernandez-Pardal J, Saaverdra J M, Reis D J. Tonic vasomotor control by the rostral ventrolateral medulla: effect of electrical or chemical stimulation of the area containing C1 adrenaline neurons on arterial pressure, heart rate, and plasma catecholamines and vasopressin. J Neurosci . 1984; 4 474-494
17 Ross C A, Ruggiero D A, Reis D J. Projections from the nucleus tractus solitarii to the rostal ventrolateral medulla. J Comp Neurol . 1985; 242 511-534
18 Blessing W W, Li Y-W. Inhibitory vasomotor neurons in the caudal ventrolateral region of the medulla oblongata. Prog Brain Res . 1989; 81 83-97
19 Ruggiero D A, Cravo S L, Arango V, Reis D. Central control of the circulation by the rostral ventrolateral reticular nucleus: Anatomical substrates. Prog Brain Res . 1989; 81 49-79
20 Reis J R, Granata A R, Tong H J, Ross C A, Ruggiero D A, Park D H. Brain stem catecholamine mechanisms in tonic and reflex control of blood pressure. Hypertension . 1984; 6(suppl II) 7-15
21 Levy E I, Clyde B, McLaughlin M R. Microvascular compression of the left medulla oblongata for severe refractory neurogenic hypertension. Neurosurgery . 1998; 43 1-9
22 Segal R. Microvascular decompression of the left lateral medulla oblongata for severe refractory neurogenic hypertension. Neurosurgery . 1999; 44 232-233