Hypertension, hyperekplexia, and pyramidal paresis due to vascular compression of the medulla

MRI showed impingement of the vertebral artery on the left lateral. medulla in two patients with arterial hypertension, exaggerated startle reflexes ( hyperekplexia), and progressive spastic paresis. One patient underwent micr ovascular decompression with normalization of arterial hypertension, disapp earance of hyperekplexia, and improvement of spastic paresis. The combinati on of arterial hypertension, hyperekplexia, and progressive spastic paresis should arouse suspicion of neurovascular compression of the lateral medull a.