Summary
The pathogenesis of essential hypertension still remains unclear. Recently, it has been supposed, that an arterial compression of the left root entry zone (REZ) of the cranial nerves IX and X by looping arteries may play a pathogenetic role. In this report we verified this hypothesis retrospectively by vertebral angiographies in 99 hypertensive and 57 normotensive patients. The angiographic findings were compared with the results obtained from an anatomic study, in which the positions of 10 left vagus/glossopharyngeal nerves in the skull were radiographically determined in 10 cadavers. By using a pattern of REZ topography developed from this information we obtained the following results: In 81% of the evaluable angiographies of hypertensive patients we found an artery in the left REZ of cranial nerves IX and X. The normotensive patients showed an artery in the REZ only in 41.7% of cases. Our results support the hypothesis that essential hypertension may be combined with neurovascular compression of the left REZ of cranial nerves IX/X.
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References
Jannetta PJ (1967) Structural mechanisms of trigeminal neuralgia: arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26: 159–162
Jannetta PJ (1977) Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 24: 538–549
Haines SJ, Jannetta PJ, Zorub DS (1980) Microvascular relations of the trigeminal nerve. J Neurosurg 52: 381–386
Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS (1977) Etiology and definitive microsurgical treatment of hemifacial spasm. J Neurosurg 47: 321–328
Jannetta PJ, Segal R (1985) Neurogenic hypertension: Etiology and surgical treatment. I. Observationes in 53 patients. Ann Surg 201: 391–398
Jannetta PJ, Gendell HM (1978) Neurovascularcompression associated with essential hypertension. Neurosurgery 2: 165
Jannetta PJ, Gendell HM (1979) Clinical observations on etiology of essential hypertension. Surg Forum 30: 431–432
Jannetta PJ, Segal R, Wolfson SK, Dujovny M, Semba A, Cook EE (1985) Neurogenic hypertension: Etiology and surgical treatment. II. Observations in an nonhuman primate model. Ann Surg 202: 253–261
Naraghi R, Gaab MR, Walter GF (1988) Neurovascular compression as an etiology of essential hypertension. A microanatomical study. In: Advances in neurosurgery 39th annual meeting of the german neurosurgical society, Cologne
Cox DR (1970) The analysis of binary data. Methuen, London
Lang J (1982) Über Bau, Länge und Gefäßbeziehungen intrazisternaler Hirnnerven. Zbl Neurochir 43: 244–247
Kazui S, Kuriyama Y, Naritomi H, Sawada T, Ogawa M, Maruyama M (1989) Estimation of vertebral arterial asymmetry by computed tomography. Neuroradiology 31: 237–239
Krayenbühl H, Yasargil MG (1979) Zerebrale Angiographie für Klinik und Praxis, 3. Aufl. Thieme, Stuttgart
Margolis MT, Newton ThH (1972) Borderland of the normal and abnormal posterior inferior cerebellar artery. Acta Radiol Diagn 13: 163–172
Margolis MT, Newton ThH (1974) The posterior inferior cerebellar artery. In: Newton ThH, Potts DJ (eds) Radiology of the skull and brain, Book 2, 1st edn. Mosby, St. Louis
Whisler WW, Voris HC (1965) Effect of bilateral glossopharyngeal nerve section on blood pressure. A case report. J Neurosurg 23: 79–81
Wycis H (1945) Bilateral intracranial section of the glossopharnygeal nerve. Report of a case. Arch Neurol Psychiatry 54: 344–347
Magnus O, Koster M, Van Der Drift JHA (1977) Cerebral mechanisms and neurogenic hypertension in man: With special reference to baroreceptor control. In: De Jong W, Provost AP, Shapiro AP (es) Hypertension and brain mechanisms. Progress in brain research, vol 47. Elsevier, Amsterdam, p 199
Baker AB, Matzke HA, Brown JR (1950) Poliomyelitis. III. Bulbarpoliomyelitis: a study of medullary function. Arch Neurol Psychiatry 63: 257
Reis DJ, Doba N, Nathan MA (1976) Neurogenic arterial hypertension produced by brainstem lesion. In: Onesti G, Fernandes M, Kim KE (eds) Regulation of blood pressure by the central nervous system. Grune & Stratton, New York San Francisco London, pp 35–51
Snyder DW, Doba N, Reis DJ (1978) Regional distribution of blood flow during arterial hypertension produced by lesions of the nucleus tractus solitarii in rats. Circ Res 42: 87–91
Peiss CN (1958) Cardiovascular response to electrical stimulation of the brain stem. J Physiol 141: 500–509
Armstrong DM, Ross CA, Pickel VM, Joh TH, Reis DJ (1982) Distribution of dopamine-, noradrenalin-, and adrenalincontaining cell bodies in the rat medulla oblongata: Demonstrated by the immunocytochemical localisation of catecholamine biosynthetic enzymes. J Comp Neurol 212: 173–187
Ross CA, Ruggiero DA, Joh TH, Park DH, Reis DJ (1983) Adrenalin synthesizing neurons in the rostral medulla: a possible role in tonic vasomotor control. Brain Res 273: 356–361
Reis DJ, Ross CA, Ruggiero DA (1984) Role of adrenaline neurons of ventrolateral medulla (the C1 group) in the tonic and phasic control of arterial pressure. Clin Exper Hyper Theory Praxis 6: 221–241
Benarroch EE, Granata AR, Ruggiero DA, Park DH, Reis DJ (1986) Neurons of C1 area mediate cardiovascular responses initiated from ventral medulla surface. Am J Physiol 250: R932-R945
Ciriello J, Caverson MM, Polosa C (1986) Function of the ventrolateral medulla in the control of the circulation. Brain Res Rev 11: 359–391
Fein JM (1981) Hypertension and central nervous system. Clin Neurosurg 29: 666–721
Fein JM, Frishman W (1980) Neurogenic hypertension related to vascular compression of the lateral medulla. Neurosurgery 6: 615–622
Segal R, Gendell HM, Canfield D, Dujovny M, Jannetta PJ (1982) Hemodynamic changes induced by pulsatile compression of the ventrolateral medulla. Angiology 33: 161–172
Segal R, Jannetta PJ, Wolfson SK, Dujovny M, Cook EE (1982) Implanted pulsatile balloon device for simulation of neurovascular compression syndroms in animals. J Neurosurg 57: 646–650
Dawes J, Widdicombe JG (1953) The afferent pathway of the Bezold reflex: The left vagal branches in dogs. Br J Pharmacol 8: 395–398
Faden AI, Jacobs TP, Woods M, Tyner CF (1978) Zona intermedia pressor sites in the cat spinal cord: right-left asymmetry. Exper Neurol 61: 571–581
Randall WC (1984) Selective automatic innervation of the heart. In: Randall WC (ed) Nervous control of cardiovascular function. Oxford University Press, New York Oxford, pp 46–67
Gunn GG, Sevelius G, Puiggari MJ, Myers FK (1968) Vagal cardiomotor mechanisms in the hindbrain of dog and cat. Am J Physiol 214: 258–262
Henry JL, Calaresu FR (1974) Exitatory and inhibitory inputs from medulla nuclei projecting to spinal cardioacceleratory neurons in the cat. Exp Brain Res 20: 485–504
Henry JL, Calaresu FR (1974) Pathways from medulla nuclei to spinal cardioacceleratory neurons in cat. Exp Brain Res 20: 506–514
Stuesse SL (1982) Origins of vagal preganglionic fibres: a retrograde transport study. Brain Res 236: 15–25
Szulczyk P, Tafil M (1980) Influence of the input from left and right arterial barorecteptors on left inferior cardiac nerve activity in cats. J Auton Nerv Syst 2: 355–364
Wong BY, Steinberg GK, Rosen L (1989) Magnetic resonance imaging of vascular compression in trigeminal neuralgia. J Neurosurg 70: 132–134
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Kleineberg, B., Becker, H. & Gaab, M.R. Neurovascular compression and essential hypertension. Neuroradiology 33, 2–8 (1991). https://doi.org/10.1007/BF00593324
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DOI: https://doi.org/10.1007/BF00593324