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Neurovascular compression and essential hypertension. An angiographic study
B Kleineberg1, H Becker, M R Gaab
1Department of Neuroradiology, Medizinische Hochschule Hannover, Federal Republic of Germany.
Insights
Arterial compression of cranial nerves IX and X may contribute to essential hypertension. This study found a higher prevalence of such neurovascular compression in hypertensive patients compared to normotensive individuals.
Area of Science:
- Neurology
- Cardiology
- Anatomy
Background:
- The exact causes of essential hypertension are not fully understood.
- A recent hypothesis suggests arterial compression of cranial nerves IX and X may be involved.
Purpose of the Study:
- To investigate the potential role of neurovascular compression in the pathogenesis of essential hypertension.
- To verify the hypothesis linking arterial loops near the cranial nerves IX/X root entry zone (REZ) to hypertension.
Main Methods:
- Retrospective analysis of vertebral angiographies in 99 hypertensive and 57 normotensive patients.
- Comparison of angiographic findings with an anatomical study of 10 cadavers to determine REZ topography.
- Radiographic determination of left vagus/glossopharyngeal nerve positions in cadavers.
Main Results:
- An artery was identified in the left REZ of cranial nerves IX and X in 81% of evaluable hypertensive patients.
- In contrast, arterial presence in the REZ was observed in only 41.7% of normotensive patients.
- A significant association was found between neurovascular compression and essential hypertension.
Conclusions:
- The findings support the hypothesis that essential hypertension may be associated with neurovascular compression.
- Compression of the left REZ of cranial nerves IX/X by arteries is a potential pathogenetic factor in essential hypertension.
Abstract:
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.