PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
 
Skull base surgery. 2000; 10(3): 149–152.
PMCID: PMC1656827

Complete Resolution of Hypertension after Decompression of Chiari I Malformation

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.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Paul KS, Lye RH, Strang FA, Dutton J. Arnold-Chiari malformation. Review of 71 cases. J Neurosurg. 1983 Feb;58(2):183–187. [PubMed]
  • 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 Sep;88(3):224–226. [PubMed]
  • Dickinson LD, Papadopoulos SM, Hoff JT. Neurogenic hypertension related to basilar impression. Case report. J Neurosurg. 1993 Dec;79(6):924–928. [PubMed]
  • Fein JM, Frishman W. Neurogenic hypertension related to vascular compression of the lateral medulla. Neurosurgery. 1980 Jun;6(6):615–622. [PubMed]
  • Jannetta PJ, Segal R, Wolfson SK., Jr Neurogenic hypertension: etiology and surgical treatment. I. Observations in 53 patients. Ann Surg. 1985 Mar;201(3):391–398. [PubMed]
  • Kleineberg B, Becker H, Gaab MR. Neurovascular compression and essential hypertension. An angiographic study. Neuroradiology. 1991;33(1):2–8. [PubMed]
  • Naraghi R, Gaab MR, Walter GF, Kleineberg B. Arterial hypertension and neurovascular compression at the ventrolateral medulla. A comparative microanatomical and pathological study. J Neurosurg. 1992 Jul;77(1):103–112. [PubMed]
  • Jannetta PJ, Segal R, Wolfson SK, Jr, Dujovny M, Semba A, Cook EE. Neurogenic hypertension: etiology and surgical treatment. II. Observations in an experimental nonhuman primate model. Ann Surg. 1985 Aug;202(2):253–261. [PubMed]
  • Segal R, Gendell HM, Canfield D, Dujovny M, Jannetta PJ. Hemodynamic changes induced by pulsatile compression of the ventrolateral medulla. Angiology. 1982 Mar;33(3):161–172. [PubMed]
  • Blessing WW, Reis DJ. Inhibitory cardiovascular function of neurons in the caudal ventrolateral medulla of the rabbit: relationship to the area containing A1 noradrenergic cells. Brain Res. 1982 Dec 16;253(1-2):161–171. [PubMed]
  • Caverson MM, Ciriello J, Calaresu FR. 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 Nov;9(2-3):451–475. [PubMed]
  • Ciriello J, Caverson MM. Bidirectional cardiovascular connections between ventrolateral medulla and nucleus of the solitary tract. Brain Res. 1986 Mar 5;367(1-2):273–281. [PubMed]
  • Ciriello J, Caverson MM, Polosa C. Function of the ventrolateral medulla in the control of the circulation. Brain Res. 1986 Dec;396(4):359–391. [PubMed]
  • Dampney RA, Goodchild AK, Robertson LG, Montgomery W. Role of ventrolateral medulla in vasomotor regulation: a correlative anatomical and physiological study. Brain Res. 1982 Oct 14;249(2):223–235. [PubMed]
  • Dormer KJ, Bedford TG. Cardiovascular control by the rostral ventrolateral medulla in the conscious dog. Prog Brain Res. 1989;81:265–277. [PubMed]
  • Ross CA, Ruggiero DA, Park DH, Joh TH, Sved AF, Fernandez-Pardal J, Saavedra JM, Reis DJ. 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 Feb;4(2):474–494. [PubMed]
  • Ross CA, Ruggiero DA, Reis DJ. Projections from the nucleus tractus solitarii to the rostral ventrolateral medulla. J Comp Neurol. 1985 Dec 22;242(4):511–534. [PubMed]
  • Blessing WW, Li YW. Inhibitory vasomotor neurons in the caudal ventrolateral region of the medulla oblongata. Prog Brain Res. 1989;81:83–97. [PubMed]
  • Ruggiero DA, Cravo SL, Arango V, Reis DJ. Central control of the circulation by the rostral ventrolateral reticular nucleus: anatomical substrates. Prog Brain Res. 1989;81:49–79. [PubMed]
  • Levy EI, Clyde B, McLaughlin MR, Jannetta PJ. Microvascular decompression of the left lateral medulla oblongata for severe refractory neurogenic hypertension. Neurosurgery. 1998 Jul;43(1):1–9. [PubMed]
  • Segal R. Microvascular decompression of the left lateral medulla oblongata for severe refractory neurogenic hypertension. Neurosurgery. 1999 Jan;44(1):232–233. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers