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The periaqueductal grey area and control of blood pressure in neurodegeneration

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Abstract

The periaqueductal/periventricular grey area (PAG/PVG) is a midbrain nucleus with an important role in pain signalling and autonomic control. We present the case of an initially hypertensive man who developed a presumed neurodegenerative disorder over a decade, characterised by progressive right-sided chronic pain, extra-pyramidal symptoms and autonomic dysfunction including postural hypotension, sleep apnoea, and bladder instability. He underwent a variety of treatments for his symptoms, including deep brain stimulation (DBS) of the PAG/PVG. 24-h blood pressure monitoring was carried out 1 and 5 years after implantation. Although the DBS initially produced a significant reduction in blood pressure, the effect was significantly reversed when the same tests were repeated 5 years after surgery. This may imply a functional involvement of the PAG/PVG in the neurodegenerative process.

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Acknowledgments

We would like to thank Neil Rane for his expert neuroradiological opinion. The research has been supported by the UK MRC, the Norman Collison Foundation, the Wolfson Foundation, the Oxford Collaborative Biomedical Research Centre and the Oxford Health Services Research Committee (OHSRC).

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Authors and Affiliations

  1. Department of Neurosurgery, University of Oxford, Level 3, West Wing, Oxford, OX3 9DU, UK

    Alexander L. Green, Tipu Z. Aziz & Erlick A. C. Pereira

  2. Nuffield Department of Surgical Science, University of Oxford, Level 3, West Wing, Oxford, OX3 9DU, UK

    Holly Sitsapesan, Alexander L. Green & Tipu Z. Aziz

Authors
  1. Holly Sitsapesan
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  2. Alexander L. Green
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  3. Tipu Z. Aziz
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  4. Erlick A. C. Pereira
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Correspondence to Holly Sitsapesan.

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Sitsapesan, H., Green, A.L., Aziz, T.Z. et al. The periaqueductal grey area and control of blood pressure in neurodegeneration. Clin Auton Res 23, 215–219 (2013). https://doi.org/10.1007/s10286-013-0206-x

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  • DOI: https://doi.org/10.1007/s10286-013-0206-x

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