Lateral medullary vascular compression manifesting as paroxysmal hypertension

L Giammattei; G Wuerzner; K Theiler; P Vollenweider; V Dunet; M Al Barajraji; J W Squair; J Bloch; R T Daniel

doi:10.1007/s00701-024-06032-y

Lateral medullary vascular compression manifesting as paroxysmal hypertension

Acta Neurochir (Wien). 2024 Mar 15;166(1):139. doi: 10.1007/s00701-024-06032-y.

Authors

L Giammattei¹, G Wuerzner², K Theiler², P Vollenweider³, V Dunet⁴, M Al Barajraji⁵, J W Squair⁵, J Bloch^{5

6

7}, R T Daniel⁵

Affiliations

¹ Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland. lorenzo.giammattei@chuv.ch.
² Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ Department of Medical Radiology, Service of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁵ Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland.
⁶ Defitech Center for Interventional Neurotherapies (NeuroRestore), CHUV/UNIL/EPFL, 1005, Lausanne, Switzerland.
⁷ Department of Clinical Neuroscience, Lausanne University Hospitzal (CHUV) and University of Lausanne (UNIL), 1005, Lausanne, Switzerland.

Abstract

Neurovascular compression of the rostral ventrolateral medulla (RVLM) has been described as a possible cause of refractory essential hypertension. We present the case of a patient affected by episodes of severe paroxysmal hypertension, some episodes associated with vago-glossopharyngeal neuralgia. Classical secondary forms of hypertension were excluded. Imaging revealed a neurovascular conflict between the posterior inferior cerebellar artery (PICA) and the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves (CN IX-X REZ). A MVD of a conflict between the PICA and the RVLM and adjacent CN IX-X REZ was performed, resulting in reduction of the frequency and severity of the episodes. Brain MRI should be performed in cases of paroxysmal hypertension. MVD can be considered in selected patients.

Keywords: Far lateral approach; Microvascular decompression; Neurogenic hypertension; Symptomatic paroxysmal hypertension; Vago-glossopharyngeal neuralgia; Ventrolateral medullary decompression.

Publication types

Case Reports

MeSH terms

Glossopharyngeal Nerve Diseases*
Humans
Hypertension* / complications
Medulla Oblongata / diagnostic imaging
Pressure
Vagus Nerve