CARDIOVASCULAR JOURNAL OF AFRICA • SAHS Biennial Congress 16-18 September 2022 57 AFRICA Submission ID: 1370 Introduction We report a rare case of severe resistant hypertension secondary to neurogenic aetiology. Neurosurgical intervention was required to improve blood pressure control. A secondary cause for hypertension may be suspected in young subjects with uncontrolled blood pressure. Here we discuss an unusual central cause for hypertension which resolved upon surgical decompression. Methods A 45-year-old male was for investigation of refractory hypertension. The early age of onset (age 29 years) and failure of medication (11 antihypertensive medications) suggested secondary hypertension. There was no history of drug abuse, renal disease, connective tissue disease or features suggestive of endocrine disease. His blood pressure was 210/119 mm Hg and equal when measured in upper and lower limbs. He did not have any renal bruits or radio-femoral delay. After an extensive workup revealed no secondary cause we proceeded to investigate for a central nervous system aetiology of hypertension. Results Magnetic resonance imaging (MRI) with angiogram showed the right posterior inferior cerebellar artery (PICA) abutting the right side of the ventrolateral medulla oblongata. The patient underwent right rectosigmoid craniotomy for microvascular decompression of the right loop of the PICA at the dorsal root entry zone of cranial nerves IX and X. After surgery the patient experienced episodes of severe headache, chest pain and tinnitus. He was eventually discharged with adequately controlled blood pressure. Conclusion Compression of the medulla oblongata is a rare cause of hypertension. Micro-decompression of the medulla oblongata has shown benefit, but the quality of the evidence is low. Sham-controlled studies with long term follow up are required to determine the efficacy of the aforementioned procedure. Name: Presenting Author Information Article Category Abstract Title King Edward VIII Tertiary Hospital, Department of Internal Medicine, Umbilo, Kwa-Zulu Natal, South Africa, ORCID ID 0000-0002-5950-1585 poobalan1naidoo@yahoo.com English Abstract Clinical Posterior inferior cerebellar artery impingement on the medulla oblongata: a case report Author Affiliation: Email: Poobalan Naidoo Authors Name & Surname Title Expertise Affiliation Email Country Poobalan Naidoo Dr General Medicine King Edward VIII Tertiary Hospital, Department of Internal Medicine, Umbilo, Kwa-Zulu Natal, South Africa poobalan1naidoo@yahoo.com South Africa Travis Chetty Dr General Medicine King Edward VIII Tertiary Hospital, Department of Internal Medicine, Umbilo, Kwa-Zulu Natal, South Africa travischetty96@gmail.com South Africa Virendra Rambiritch Prof Pharmacology University of Kwa-Zulu Natal, Discipline of Pharmaceutical Sciences, Kwa-Zulu Natal, South Africa rambiritchv@ukzn.ac.za South Africa Rory Leisegang Dr Clinical Pharmacology Department of Pharmaceutical Biosciences, Uppsala University, 752 36, Uppsala, Sweden rory.leisegang@gmail.com Sweden Yeskhkir Naidoo Dr Radiology Inkosi Albert Luthuli Central Hospital, Department of Radiology, Cato Manor, Kwa-Zulu Natal, South Africa yesh.brightside@gmail.com South Africa Sumanth Karamchand Dr Cardiology Division of Cardiology, Tygerberg Hospital, Cape Town, Western Cape, South Africa sum801@gmail.com South Africa POSTER PRESENTATION
RkJQdWJsaXNoZXIy NDIzNzc=