Hypertension is a major risk factor for stroke. Neurovascular compression (NC) of the left ventrolateral medulla oblongata may cause arterial hypertension. We evaluated the relationship between the two ischemic stroke patients. We classified 69 patients under 50 years old (49 men and 20 women, aged 43.6 ± 7.3 years) based on magnetic resonance imaging findings as follows: NC patients (n = 38; 10 with NC on the right side, 18 with NC on the left side, and 10 with NC on both sides) and non-NC patients (n = 31). We compared the following clinical characteristics between the two groups: (1) risk factors for stroke, including hypertension, diabetes mellitus, hypercholesterolemia, and smoking and (2) stroke subtype. Hypertension was more frequent in the NC group than in the non-NC group (58 vs. 19%, p = 0.001). Hypertension was more frequent in patients with left-side NC than in those with right-side NC (78 vs. 20%, p = 0.005). No other differences were observed between the two groups. Twelve patients presented with atherothrombotic stroke, 16 with cardioembolic stroke, 24 with lacunar stroke and 17 with stroke of miscellaneous etiology. NC was significantly more common in patients with lacunar stroke as compared with those affected by other stroke subtypes (p = 0.015). We found a significant relationship between hypertension and NC of the ventrolateral medulla oblongata on the left side in ischemic stroke patients younger than 50 years of age. Some patients with lacunar stroke may have hyptertension related to NC.

1.
Callaresu FR, Yardley CP: Medullary basal sympathetic tone. Annu Rev Physiol 1988;50:511–524.
2.
Ciriello J, Caverson MM, Polosa C: Function of the ventrolateral medulla in the control of the circulation. Brain Res 1986;396:359–391.
3.
Morimoto S, Sasaki S, Miki S, Kawa T, Itoh H, Nakata T, Takeda K, Nakagawa M, Naruse S, Maeda T: Pulsatile compression of the rostral ventrolateral medulla in hypertension. Hypertension 1997;29:514–518.
4.
Morimoto S, Sasaki S, Miki S, Kawa T, Nakamura K, Ichida T, Itoh H, Nakata T, Takeda K, Nakagawara M, Yamada H: Pressor response to compression of the ventrolateral medulla mediated by glutamate receptors. Hypertension 1999;33:1207–1213.
5.
Jannetta PJ, Gendell HM: Neurovascular compression associated with essential hypertension (abstract). Neurosurgery 1978;2:165.
6.
Jannetta PJ, Gendell HM: Clinical observations on etiology of essential hypertension. Surg Forum 1979;30:431–432.
7.
Fein JM, Frishman W: Neurogenic hypertension related to vascular compression at the lateral medulla. Neurosurgery 1980;6:615–622.
8.
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;202:253–261.
9.
Kleineberg B, Becker H, Gaab MR, Naraghi R: Essential hypertension associated with neurovascular compression: Angiographic findings. Neurosurgery 1992;30:834–841.
10.
Naraghi R, Gaab MR, Walter GF, Kleineberg B: Arterial hypertension and neurovascular compression at the ventrolateral medulla. J Neurosurg 1992;77:103–112.
11.
Naraghi R, Geiger H, Crnac J, Huk W, Fahlbusch R, Engels G, Luft FC: Posterior fossa neurovascular anomalies in essential hypertension. Lancet 1994;334:1466–1470.
12.
Jannetta PJ, Segal R, Wolfson SK Jr: Neurogenic hypertension: Etiology and surgical treatment. I. Observation in 53 patients. Ann Surg 1985;201:391–398.
13.
Levy EL, Clyde B, McLaughlin MR, Jannetta PJ: Microvascular decompression of the lateral medulla oblongata for severe refractory neurogenic hypertension. Neurosurgery 1998;43:1–9.
14.
Morimoto S, Sasaki S, Takeda K, Furuya S, Naruse S, Matsumoto K, Higuchi T, Saito M, Nakagawa M: Decreases in blood pressure and sympathetic nerve activity by microvascular decompression of the rostral ventrolateral medulla in essential hypertension. Stroke 1999;30:1707–1710.
15.
Geiger H, Naraghi R, Schobel HP, Frank H, Sterzel RB, Fahlbusch R: Decrease of blood pressure by ventrolateral medullary decompression in essential hypertension. Lancet 1998;352:446–449.
16.
Akimura T, Furutani Y, Jimi Y, Saito K, Kashiwagi S, Kato S, Ito H: Essential hypertension and neurovascular compression at the ventrolateral medulla oblongata: MR evaluation. AJNR 1995;16:401–405.
17.
Morimoto S, Sasaki S, Miki S, Kawa T, Itho H, Nakata T, Takeda K, Nakagawa M, Kizu O, Furuya S, Naruse S, Maeda T: Neurovascular compression of the rostral ventrolateral medulla related to essential hypertension. Hypertension 1997;30:77–82.
18.
Colon GP, Quint DJ, Dickinson LD, Brunberg JA, Jamerson KA, Hoff JT, Ross DA: Magnetic resonance evaluation of ventrolateral medullary compression in essential hypertension. J Neurosurg 1998;88:226–231.
19.
Johnson DR, Coley C, Brown J, Moseley IF: The role of MRI in screening for neurogenic hypertension. Neuroradiology 2000;42:99–103.
20.
National Institute of Neurological Disorders and Stroke Ad Hoc Committee: Classification of cerebrovascular diseases. Stroke 1990;21:637–676.
21.
National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Arch Intern Med 1993;153:186–208.
22.
Fisher CM: Capsular infarcts: The underlying vascular lesions. Arch Neurol 1979;36:65–73.
23.
Granata A, Ruggiero DA, Park DH, Joh TH, Reis DJ: Brain stem area with C1 epinephrine neurons mediates baroreflex vasodepressor responses. Am J Physiol 1985;17:547–567.
24.
Morise T, Horita M, Kitagawa I, Shinzato R, Hoshiba Y, Masuya H, Suzuki M, Takekoshi N: The potent role of increased sympathetic tone in pathogenesis of essential hypertension with neurovascular compression. J Hum Hypertens 2000;14:807–811.
25.
Makino Y, Kawano Y, Okuda N, Horio T, Iwashima V, Yamada N, Takamiya M, Takishita S: Autonomic function in hypertensive patients with neurovascular compression of the ventrolateral medulla oblongata. J Hypertens 1999;17:1257–1263.
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