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Neurovascular compression syndromes and hypertension: clinical relevance

Nature Clinical Practice Neurology volume 3, pages 416–417 (2007)Cite this article

Neurovascular compression (NVC) occurs as a result of pressure on a nerve by a blood vessel. In the field of neuroscience, the concept of NVC syndrome as a clinical entity has its roots dating back more than 70 years. Dandy first highlighted NVC as a cause of trigeminal neuralgia (TN) in the early 1930s,1 and in 1959 Gardner and Miklos demonstrated successful treatment of the condition by surgical decompression.2 In the late 1970s, Jannetta popularized the concept of NVC syndrome, which unifies a spectrum of neurological conditions such as TN and glossopharyngeal neuralgia (somatic sensory system), hemifacial spasm (HFS; somatic motor system), and tinnitus and vertigo (special sensory system).3,4 Subsequently, Jannetta and Gendell proposed the theory of 'neurogenic hypertension', which states that pulsatile vascular compression of the left ventrolateral medulla (VLM) could predispose individuals to hypertension.4 In 1985, Jannetta reported successful microvascular decompression (MVD) surgery and normalization of blood pressure in 32 of 36 hypertensive patients with NVC syndromes.5

Given that arterial hypertension is an important risk factor for stroke and many chronic diseases, the notion of neurogenic hypertension—which unifies the patho-etiology of a group of neurological conditions—has attracted widespread interest amongst the different subspecialists in medicine. The intriguing hypothesis of neurogenic hypertension has been supported by the observation that left-sided pulsatile compression of the medulla elevates blood pressure in primates.6 In rats, neurons of this region (the C1 area) directly innervate preganglionic neurons in the spinal cord, and are tonically active and sympatho-excitatory.7 The discharge of C1-area neurons is in sync with the cardiac cycle and results in firing of sympathetic preganglionic neurons. The C1-area neurons also control the vascular component of baroreceptor reflexes.7

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Acknowledgements

We thank the National Medical Research Council, Singapore, for their support.

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  1. E-K Tan is a Senior Consultant Neurologist and Clinician Scientist at the National Neuroscience Institute, and L-L Chan is a Senior Neuroradiologist at Singapore General Hospital, Singapore.,

    Eng-King Tan & Ling-Ling Chan

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Correspondence to Eng-King Tan.

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Tan, EK., Chan, LL. Neurovascular compression syndromes and hypertension: clinical relevance. Nat Rev Neurol 3, 416–417 (2007). https://doi.org/10.1038/ncpneuro0558

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