Cardiovascular Center (medulla):

  • regulates cardiac output (modified heart rate, stroke volume, vascular tone via sympathetic / parasympathetic stimulation).
  • responds to baroreceptor signals (stretch) and chemoreceptors signals (PO2 / PCO2)

Rostral Ventrolateral Medulla and upper cervical spinal cord region:

  • play a key role in central BP control
  • High cervical SCI associated with very erratic BP
  • Dysregulated neural net rows dynamics in caudal pressors regions implicated in development of HTN

Higher Brain Regions:

  • I.e. cerebral cortex, hypothalamus, Lim nic system
  • Modulates brainstem control centers
  • Based on studies of patients undergoing intraoperative stimulation of insula before temporal lobe tiny for seizure control:
    • Stimulation of L insular cortex – produces bradycardia and depressor responses
    • Stimulation of R insular cortex – produces tachycardia and pressor effects (i.e. R dominance for sympathetic cardiovascular effects)
  • R MCA infarction May disinhibition insular function –> increased sympathetic cardiovascular tone

*NOTE TO SELF: short term rise in BP after stroke – compensatory, no need to treat. Chronic high blood pressure – likely renally mediated, requires treatment. (?)

Reference:

Kelly, D., & Rothwell, P. (2019). Blood pressure and the brain: the neurology of hypertension. Practical Neurology, practneurol-2019-002269. doi: 10.1136/practneurol-2019-002269.

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