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Relationship of neurovascular compression to central sympathetic discharge and essential hypertension

Paul A. Smith, MB, ChB^*,*, James F. M. Meaney, FRCR, Lee N. Graham, MB, ChB^*, John B. Stoker, BSc, MB, ChB^*, Alan F. Mackintosh, MA, MD^*, David A. S. G. Mary, MB, ChB, PhD^* and Stephen G. Ball, MB, BChir, PhD^*

^* Departments of Cardiology and Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
MRI Department, St. James's Hospital, Dublin, Ireland

View larger version (94K): [in a new window]   Figure 1 An example of a "positive" case of NVC. (A) An axial image just below the pontomedullary junction (PMJ) showing a vessel in contact with the left ventrolateral medulla (solid arrow). The two high-signal-intensity structures (solid and open arrows) represent a high-looping left posterior inferior cerebellar artery (PICA). The reformatted maximum intensity projection (MIP) angiogram images demonstrate a high-looping left PICA in the lateral (B) and antero-posterior (C) projections. Note the position of the loop in relation to the PMJ. The position of the slice shown in A is denoted by the dotted line for reference. C = cerebellum; M = medulla; P = pons.

View larger version (19K): [in a new window]   Figure 2 (A) Muscle sympathetic nerve activity (MSNA) (open bars) and (B) single-unit MSNA (s-MSNA) (solid bars) cardiac baroreceptor reflex sensitivity (BRS) in subjects with neurovascular compression, NVC (+), and without, NVC (–). The numbers in parentheses below the x-axis represent the number of subjects. Data are expressed as the mean (height of columns) ± SEM (bars). The unpaired t test was used to test for statistical significance (ns = not significant).

View larger version (26K): [in a new window]   Figure 3 Sympathetic activity quantified per 100 cardiac beats in groups classified according to the level of arterial pressure. The numbers in parentheses below the x-axis represent the proportions and ratios of subjects with neurovascular compression. Analysis of variance with Newman-Keuls post-test comparisons was used to determine statistical significance. Compared with normal subjects (NT): *p < 0.05, °p < 0.01, p < 0.001. Compared with high-normal arterial pressure subjects (HN): p < 0.05, ||p < 0.001. Compared with mild essential hypertension subjects (EHT-1): ¶p < 0.05. EHT-2/3 = severe essential hypertension subjects; MSNA = muscle sympathetic nerve activity; s-MSNA = single-unit muscle sympathetic nerve activity.