The effects of hyperbaric oxygen therapy on paroxysmal sympathetic hyperactivity after cardiopulmonary resuscitation: a case series

The onset of cardiac arrest (CA) is sudden and critical.Due to cerebral ischaemia and hypoxia, the prognosis for post-cardiopulmonary resuscitation (CPR) patients is poor. Paroxysmal sympathetic hyperexcitability (PSH) is a potentially life-threatening condition, which is characterized by episodes of increased heart rate and blood pressure,sweating, hypothermia, and forced posture.[1] Hypoxicischaemic encephalopathy post-CPR can lead to PSH,which often indicates a worse prognosis.

Investigation of spatial structure and sympathetic cooling in the^(9)Be^(+)–^(40)Ca^(+)bi-component Coulomb crystals

We study the spatial structure and sympathetic cooling of the bi-component Coulomb crystal(CC),which consists of approximate 450^(9)Be^(+)ions and 450^(40)Ca^(+)ions with a mass ratio of 0.225 in a segmented linear ion trap.By twodimensional imaging of the bi-component CC,the^(9)Be^(+)ions are found to be surrounded by the^(40)Ca^(+)ions in the radial direction with a separation ratio of~2.0,and the axial length of the^(9)Be^(+)ions occupied area is much larger than that of the^(40)Ca^(+)ions occupied area.Combined with the previous experimental results,the structure of the^(9)Be^(+)–^(40)Ca^(+)CC shows the larger the difference in the mass–charge ratio,the larger the separation between the two species.The comparison of the fluorescence spectra of the^(9)Be^(+)ions in the bi-component CC and the pure CC indicates that the^(9)Be^(+)ions can be sympathetically cooled and stably localized by the laser-cooled^(40)Ca^(+)ions during the recording of the fluorescence spectrum.

Sympathetic electromagnetically induced transparency ground state cooling of a~(40)Ca^(+)–~(27)Al^(+)pair in an~(27)Al^(+)clock

We report on electromagnetically induced transparency cooling of ^(40)Ca^(+)to sympathetically cool the threedimensional secular modes of motion in a ^(40)Ca^(+)–^(27)Al^(+)two-ion pair near the ground state.We observe simultaneous ground state cooling across all radial modes and axial modes of a ^(40)Ca^(+)–^(27)Al^(+)ion pair,occupying a broader cooling range in frequency space over 3 MHz.The cooling time is observed to be less than 1 ms.The mean phonon number and heating rates of all motional modes are measured.This study is not only an important step for reducing the secular motion time-dilation shift uncertainty and uptime ratio of ^(27)Al^(+)optical clock,but also essential for high-fidelity quantum simulations and quantum information processors using trapped ions.

Brachial arteries sympathetic innervation: A contribution to anatomical knowledge

BACKGROUND The sympathetic nervous system makes medium and large peripheral arteries smaller to slow the blood flowing through them.AIM To observe brachial artery sympathetic innervation.METHODS We developed a neurophysiological autonomous test that measured the effects of peripheral sympathetic fibres on peripheral arteries.Our specific objective was to find the sympathetic innervation of the brachial artery.To accomplish this purpose,the brachial artery baseline diameter and flow rate were measured in the right arm of the patients.Afterwards,electrical stimulus was applied to the medial nerve for 5 s.Through electrical sympathetic activation,the vessel diameter and overall flow rate will decrease.After 7 d,a similar experiment was repeated using the ulnar nerve.RESULTS The differences in diameter and flow rate of the brachial artery in response to median and ulnar nerve activation were compared.In the total group,no significant difference in diameter was seen between medial and ulnar nerve stimulation(P=0.648).The difference in absolute slowdown of flow rate between median nerve stimulation and ulnar nerve stimulation was not statistically significant for the entire group(P=0.733).CONCLUSION As a target organ,the brachial artery receives an equal amount of sympathetic innervation from the median and the ulnar nerves.

Modulation of spontaneous activities in chronically compressed dorsal root ganglion neurons in rats by sympathetic efferent activation

Objective: To study sympathetic-sensory coupling in chronically compressed dorsal root ganglion (DRG) neurons in rats. Methods: In chronically compressed DRG model, the spontaneous activity of single fiber from the injured DRG neuron was recorded, and lumbar sympathetic trunk was electrical stimulated to study the sympathetic modulation of spontaneous activities in injured DRG neurons. Results: Fifty-seven percent of spontaneous active neurons of injured DRG responded to sympathetic stimulation. The responses included simple excitation, excitation followed by inhibition and simple inhibition. The responses enhanced with the increase of sympathetic stimulation time. The responses to sympathetic stimula- tion could be blocked by intravenously injection of phentolamine, a-adrenorecepor antagonist. Fifty-three percent of injured DRG responded to norepinephrine (NE). The responses to NE were similar to those induced by sympathetic stimulation. Conclusion: Sympathetic-sensory coupling is virtually present in chronic compressed DRG neurons. NE released from sympathetic nerve terminals acts on a-adrenorecepor to influence spontaneous activities of injured DRG neurons.

Visit-to-Visit Blood Pressure Variability Are Associated with an Imbalance between Sympathetic and Parasympathetic Tone in Hypertensive Patients

Greater fluctuations in office blood pressure increase the risk of stroke and blood pressure volatility is an important risk factor for cardiovascular events. Effects of sympathetic and parasympathetic nerve on blood pressure regulation are well known, however, those on visit-to visit variation remains unclear. Aim of this study is to clarify the contribution of sympathetic and parasympathetic balance on blood pressure fluctuation. Methods: We enrolled 23 outpatients with essential hypertension. We measured blood pressure, and pulse rate at clinic 14 times in a row and calculated coefficient of variance (CV) as visit-to-visit variability. The velocity of pupil contraction, miosis (VC) and dilation, mydriasis (VD) was determined from pupillary function test. Results: Systolic blood pressure and diastolic blood pressure were not significantly correlated with VC, VD and VD/VC. Heart rate was not correlated with VC and VD, but significantly correlated with VD/VC. CV of systolic blood pressure, diastolic blood pressure and heart rate were not significantly correlated with VC or VD. Ratio of VD to VC significantly negative correlated with CV of blood pressure, diastolic blood pressure, and heart. Value of VD was significantly correlated with value of VC. Conclusion: Visit-to-visit variability of blood pressure and heart rate is not related with sympathetic or parasympathetic tone independently but augmented by the impaired sympathetic and parasympathetic balance.

Lower limb pain in sympathetic-sensory coupling

Previous studies have shown that sympathetic nerves are related to certain types of pain, and this phenomenon is referred to as sympathetic-sensory coupling. Chronic pain resulting from nerve injury can be exacerbated by sympathetic stimulation or relieved by sympathetic inhibition. In the present study, the correlation between pain and sympathetic nerves was analyzed in patients with severe pain in lower limbs, as we^l as in a chronically compressed dorsa~ root ganglion ~CCD） rat model （model of low back pain and sciatica）. Patients with severe pain in the lower limbs underwent chemical lumbar sympathectomy （CLS）, and the analgesic effects of CLS were compared with painkillers. Results demonstrated significantly relieved lower limb pain following CLS, and the analgesic effects of CLS were superior to those seen with painkillers. In the CCD rat model, dorsal root ganglion neuronal activity significantly increased as a result of electrical stimulation to the sympathetic nerves. These results suggest that sympathetic nerves are closely associated with pain and sympathetic-sensory coupling is likely in lower limb pain in both patients and rat models of CCD.

Morphologic Relationship between the Pontine Micturition Center and the Sympathetic Center in the Spinal Cord of the Rat

To study whether the sympathetic nerves coordinate with the parasympathetic nerves during micturition in the rat. We used antegrade neural tracing with biotinylated dextran amine (BDA) injected into the pontine micturition center (PMC) to label the terminals in the L6-S1 cord. Preganglionic parasympathetic neurons (PPNs) in the L6-S1 segment were labelled by retrograde transport of Fluorogold (FG) from the major pelvic ganglion (MPG).We detected retrograde neurons in L6-S1 using retrograde transport of horseradish peroxidase (HRP) from the intermediolateral cell column (IML) of the L1-L2 segment where sympathetic preganglionic neurons (SPNs) are located. Immunohistochemical methods showed that PPNs were identified to be choline acetyltransferase-immunoreactive (ChAT-IR). HRP-labelled neurons were not ChAT-IR and located dorsal to PPNs. BDA-labelled terminals were located mainly in the bilateral IML of L6-S1, some of which had synaptic contact with the HRP-labelled neurons. In addition, there were some wheat germ agglutinin-horseradish peroxidase (WGA-HRP) labelled terminals in the ipsilateral IML of the L1-L2 segment after WGA-HRP was microinjected into SPN. We conclude that PMC may control the preganglionic neurons of sympathetic nerves through the interneurons located dorsal to PPNs.

Excessive parasympathetic responses to sympathetic challenges: a treatable, hidden, dynamic autonomic imbalance

Background:A common assumption with autonomic assessment is that one branch opposes the other.With independent measures of parasympathetic (P) and sympathetic (S) ac tivity,based on concurrent time-frequency analysis of respiratory activity and heart rate variability,this assumption has been challenged.Clinical observations of unprovoked P-excess during S-stimulation have been associated with treatable,abnormal responses.Method:Serial autonomic profiling of 12,967 patients was performed using the P&S method (ANX-3.0 Autonomic Monitor by ANSAR Medical Technologies,Inc.,Philadelphia,PA) over a five-year period.Treatment protocols are very low-dose and depend on patient history.For cardiovascular disease patients,Carvedilol was prescribed.For non-CVD patients,Nortriptyline was prescribed.In some cases where end-organ effects were not yet presented or relieved,patients were weaned of therapy once PE was relieved.Alternative therapies included Specific Chiropractic Adjustment,better known in the literature as Chiropractic Manipulative Therapy and intensive zero-impact,cardiovascular exercise.Results:PE patients present with normal HR and BP and no other apparent symptoms at rest.However,they reported symptoms of:sleep difficulties,palpitations,poor peripheral circulation,general malaise,depression (often with anxiety or ADD-like symptoms),frequent headache or migraines,menopause difficulties in women,hypothyroidism,cognitive difficulties,gastrointestinal upset,persistent weight-gain,and dizziness after standing.Conclusion:Normalizing PE,regardless of method,stabilizes the patient,relieves symptoms,improves quality of life,and improves patient outcomes.

Electroacupuncture at ST36 modulates gastric motility via vagovagal and sympathetic reflexes in rats

BACKGROUND Electroacupuncture(EA) at ST36 can significantly improve gastrointestinal symptoms, especially in promoting gastrointestinal motility. The automatic nervous system plays a main role in EA, but few studies exist on how vagovagal and sympathetic reflexes affect EA to regulate gastrointestinal motility.AIM To study the role of vagovagal and sympathetic reflexes in EA at ST36, as well as the associated receptor subtypes that are involved.METHODS Gastric motility was measured with a manometric balloon placed in the gastric antrum area in anesthetized animals. The peripheral nervous discharge was measured using a platinum electrode hooking the vagus or greater splanchnic nerve, and the central nervous discharge was measured with a glass microelectrode in the dorsal motor nucleus of the vagus(DMV). The effects and mechanisms of EA at ST36 were explored in male Sprague-Dawley rats which were divided in to a control group, vagotomy group, sympathectomy group, and microinjection group [including an artificial cerebrospinal fluid group, glutamate(L-Glu) group, and γ-aminobutyric acid(GABA) group] and in genetically modified male mice [β1β2 receptor-knockout(β1β2^(-/-)) mice, M2M3 receptorknockout(M2M3^(-/-)) mice, and wild-type control mice].RESULTS EA at ST36 promoted gastric motility during 30-120 s. During EA, both vagus and sympathetic nerve discharges increased, with a much higher frequency of vagus nerve discharge than sympathetic discharge. The gastric motility mediated by EA at ST36 was interdicted by vagotomy. However, gastric motility mediated by EA at ST36 was increased during 0-120 s by sympathectomy, which eliminated the delay effect of EA during 0-30 s, but it was lower than the control group during 30-120 s. Using gene knockout mice and their wild-type controls to explore the receptor mechanisms, we found that EA at ST36 decreased gastric motility in M2/3^(-/-) mice, and promoted gastric motility in β1/2^(-/-) mice. Extracellular recordings showed that EA at ST36 increased spikes of the DMV. Microinjection of L-Glu into the DMV increased gastric motility, while EA at ST36 decreased gastric motility during 0-60 s, and promoted gastric motility during 60-120 s.Injection of GABA reduced or increased gastric motility, and reduced the promoting gastric motility effect of EA at ST36.CONCLUSION These data suggest that EA at ST36 modulates gastric motility via vagovagal and sympathetic reflexes mediated through M2/3 and β1/2 receptors, respectively.Sympathetic nerve activity mediated through β1/2 receptors is associated with an early delay in modulation of gastric motility by EA at ST36.

Electroacupuncture at ST25 inhibits jejunal motility:Role ofsympathetic pathways and TRPV1

AIM: To investigate whether electroacupuncture(EA) at ST25 affects jejunal motility in vivo and if so, whether a sympathetic pathway is involved.METHODS: Jejunal motility was assessed using a manometric balloon placed in the jejunum approximately about 3-5 cm away from the suspensory ligament of the duodenum in anesthetized animals. The effects of EA at ST25 were measured in male Sprague-Dawley rats, some of which were treated with propranolol or clenbuterol(EA intensities: 1, 3, 5, 7, and 9 m A), and in male transient receptor potential vanilloid-1(TRPV1)(capsaicin receptor) knockout mice(EA intensities: 1, 2, and 4 m A).RESULTS: Anesthetized rats exhibited three types of fasting jejunal motor patterns(types A, B, and C), and only type C rats responded to EA stimulation. In type C rats, EA at ST25 significantly suppressed the motor activity of the jejunum in an intensity-dependent manner. The inhibitory effect of EA was weakened by propranolol(β adrenoceptor antagonist) and disappeared with clenbuterol(β adrenoceptor agonist) induced inhibition of motility, suggesting that the effect of EA on motility is mediated via a sympathetic pathway. Compared with wild-type mice, EA at ST25 was less effective in TRPV1 knockout mice, suggesting that this multi-modal sensor channel participates in the mechanism. CONCLUSION: EA at ST25 was found to inhibit jejunal motility in an intensity-dependent manner, via a mechanism in which sympathetic nerves and TRPV1 receptors play an important role.

Sympathetic nervous system activation and heart failure:Current state of evidence and the pathophysiology in the light of novel biomarkers

Heart failure(HF)is a complex clinical syndrome characterized by the activation of at least several neurohumoral pathways that have a common role in maintaining cardiac output and adequate perfusion pressure of target organs and tissues.The sympathetic nervous system(SNS)is upregulated in HF as evident in dysfunctional baroreceptor and chemoreceptor reflexes,circulating and neuronal catecholamine spillover,attenuated parasympathetic response,and augmented sympathetic outflow to the heart,kidneys and skeletal muscles.When these sympathoexcitatory effects on the cardiovascular system are sustained chronically they initiate the vicious circle of HF progression and become associated with cardiomyocyte apoptosis,maladaptive ventricular and vascular remodeling,arrhythmogenesis,and poor prognosis in patients with HF.These detrimental effects of SNS activity on outcomes in HF warrant adequate diagnostic and treatment modalities.Therefore,this review summarizes basic physiological concepts about the interaction of SNS with the cardiovascular system and highlights key pathophysiological mechanisms of SNS derangement in HF.Finally,special emphasis in this review is placed on the integrative and up-to-date overview of diagnostic modalities such as SNS imaging methods and novel laboratory biomarkers that could aid in the assessment of the degree of SNS activation and provide reliable prognostic information among patients with HF.

Sympathetic skin response:a new test to diagnose erectile dysfunction

Aim: Electrophysiological monitoring of the activity of the penile sympathetic skin responses (PSSR) in healthy menand patients with erectile dysfunction (ED). Methods: PSSR were recorded from the skin of penis with disk elec-trodes at the time of electric stimulation of left median nerves. Results: PSSR were recorded from all the healthymen and almost all the patients. In healthy men the latency of P_0, the latency of N_1, the duration of N_1 and the ampli-tude of N_1 were 1249 ± 111 ms, 2239 ± 286 ms, 1832 ± 505 ms and 470 μV (median), respectively. In ED patientsthe latency of P_0, the latency of N_1, the duration of N_1 and the amplitude of N_1 were 1467 ± 183 ms ( P < 0.01), 2561± 453 ms (P < 0.05), 2560 ± 861 ms (P < 0.01 ) and 91 μV (P < 0.01), respectively. The normal latency of Powas less than 1471 ms. The normal amplitude of N1 was more than 235μV. According to this normal value, of 20 pa-tients 11 showed longer latency of P_0, and 14 showed lower amplitude of N_1 as compared with those of normal subjects.Conclusion: PSSR can be used as an electrophysiological method in assisting the diagnosis of ED.(Asian J Androl 2001; Mar; 3: 45-48)

Renal sympathetic nervous system and the effects of denervation on renal arteries

Resistant hypertension is associated with chronic activation of the sympathetic nervous system resulting in various comorbidities. The prevalence of resistant hypertension is often under estimated due to various reasons. Activation of sympathetic nervous system at the renal-as well as systemic-level contributes to the increased level of catecholamines and resulting increase in the blood pressure. This increased activity was demonstrated by increased muscle sympathetic nerve activity and renal and total body noradrenaline spillover. Apart from the hypertension, it is hypothesized to be associated with insulin resistance, congestive heart failure and obstructive sleep apnea. Renal denervation is a novel procedure where the sympathetic afferent and efferent activity is reduced by various techniques and has been used successfully to treat drug-resistant hypertension improvement of various metabolic derangements.Renal denervation has the unique advantage of offering the denervation at the renal level, thus mitigating the systemic side effects. Renal denervation can be done by various techniques including radiofrequency ablation, ultrasound guided ablation and chemical ablation. Various trials evaluated the role of renal denervation in the management of resistant hypertension and have found promising results. More studies are underway to evaluate the role of renal denervation in patients presenting with resistant hypertension in different scenarios. Appropriate patient selection might be the key in determining the effectiveness of the procedure.

Olfactory ensheathing cell transplantation improves sympathetic skin responses in chronic spinal cord injury

Forty-three patients with chronic spinal cord injury for over 6 months were transplanted with bryonic olfactory ensheathing cells, 2-4 × 106, into multiple sites in the injured area under the sur-gical microscope. The sympathetic skin response in patients was measured with an electromyo-graphy/evoked potential instrument 1 day before transplantation and 3-8 weeks after trans-tion. Spinal nerve function of patients was assessed using the American Spinal Injury Association impairment scale. The sympathetic skin response was elicited in 32 cases before olfactory en-sheathing celltransplantation, while it was observed in 34 cases after transplantation. tantly, sympathetic skin response latency decreased significantly and amplitude increased cantly after transplantation. Transplantation of olfactory ensheathing cells also improved American Spinal Injury Association scores for movement, pain and light touch. Our findings indicate that factory ensheathing celltransplantation improves motor, sensory and autonomic nerve functions in patients with chronic spinal cord injury.

Renal sympathetic denervation in therapy resistant hypertension-pathophysiological aspects and predictors for treatment success

Many forms of human hypertension are associated with an increased systemic sympathetic activity. Especially the renal sympathetic nervous system has been found to play a prominent role in this context. Therefore, catheterinterventional renal sympathetic denervation(RDN) has been established as a treatment for patients suffering from therapy resistant hypertension in the past decade. The initial enthusiasm for this treatment was markedly dampened by the results of the Symplicity-HTN-3 trial, although the transferability of the results into clinical practice to date appears to be questionable. In contrast to the extensive use of RDN in treating hypertensive patients within or without clinical trial settings over the past years, its effects on the complex pathophysiological mechanisms underlying therapy resistant hypertension are only partly understood and are part of ongoing research. Effects of RDN have been described on many levels in human trials: From altered systemic sympathetic activity across cardiac and metabolic alterations down to changes in renal function. Most of these changes could sustainably change long-term morbidity and mortality of the treated patients, even if blood pressure remains unchanged. Furthermore, a number of promising predictors for a successful treatment with RDN have been identified recently and further trials are ongoing. This will certainly help to improve the preselection of potential candidates for RDN and thereby optimize treatment outcomes. This review summarizes important pathophysiologic effects of renal denervation and illustrates the currently known predictors for therapy success.

Renal sympathetic denervation in resistant hypertension

Resistant hypertension remains a major clinical problem despite the available multidrug therapy.Over the next decades,its incidence will likely increase given that it is strongly associated with older age and obesity.Resistant hypertension patients have an increased cardiovascular risk,thus effective antihypertensive treatment will provide substantial health benefits.The crosstalk between sympathetic nervous system and kidneys plays a crucial role in hypertension.It influences several pathophysiological mechanisms such as the central sympathetic tone,the sodium balance and the systemic neurohumoral activation.In fact,studies using several animal models demonstrated that the renal denervation prevented and attenuated hypertension in multiple species.Large reductions in blood pressure were also observed in malignant hypertension patients submitted to sympathectomy surgeries.However,these approaches had an unacceptably high rates of periprocedural complications and disabling adverse events.Recently,an innovative non-pharmacological therapy that modulates sympathetic activation has been successfully developed.Renal sympathetic percutaneous denervation is an endovascular procedure that uses radiofrequency energy to destroy the autonomic renal nerves running inside the adventitia of renal arteries.This method represents a promising new approach to the strategy of inhibiting the sympathetic nervous system.The aim of this review is to examine the background knowledge that resulted in the development of this hypertension treatment and to critically appraise the available clinical evidence.

Neuroanatomy and clinical analysis of the cervical sympathetic trunk and longus colli

Anterior cervical surgery is commonly used for cervical vertebral body lesions. However, the structure of blood vessels and nerve tissues along the route of anterior cervical surgery is complex. We aimed to measure the data of the longus colli, the sympathetic trunk and the cervical sympathetic trunk （CST） ganglia in Chinese cadaver speci- mens. A total of 32 adult cadavers were studied. We delineated the surgical anatomy of the CST. The superior and inferior/cervicothoracic ganglia of the sympathetic trunk consistently appeared. The middle ganglion was observed in 28.1% of the specimens and there were 2 cases of unilateral double middle cervical ganglia. The inferior ganglion was observed in 25.0% of the specimens and the cervicothoracic ganglion was observed in the remaining speci- mens. The distance between the CST gradually decreased from the top to the bottom, and the distance between the medial edges of the longus colli gradually broadened from the top down. The average angle between the bilat- eral CST and the midline of the vertebra was 11.2°± 1.8° on the left side and 10.3°± 1.4° on the right side. The average angle between the medial margins of longus colli of both sides was 11.1°± 1.9°. The CST is at high risk when LC muscle is cut transversely or is dragged heavily, especially at the levels of C6 and C7. Awareness of the regional anatomy of the CST could help surgeons to identify and preserve it during anterior cervical surgeries.

Enhanced sympathetic activity and cardiac sympathetic afferent reflex in rats with heart failure induced by adriamycin

Our previous studies have shown that the cardiac sympathetic afferent reflex is enhanced in rats with chronic heart failure （CHF） induced by coronary artery ligation and contributes to the over-excitation of sympathetic ac- tivity. We sought to determine whether sympathetic activity and cardiac sympathetic afferent reflex were en- hanced in adriamycin-induced CHF and whether angiotensin II （Ang II） in the paraventricular nucleus （PVN） was involved in enhancing sympathetic activity and cardiac sympathetic afferent reflex. Heart failure was induced by intraperitoneal injection of adriamycin for six times during 2 weeks （15 mg/kg）. Six weeks after the first injec- tion, the rats underwent anesthesia with urethane and a-chloralose. After vagotomy and baroreceptor denervation, cardiac sympathetic afferent reflex was evaluated by renal sympathetic nerve activity and mean arterial pressure （MAP） response to epicardial application of capsaicin （1.0 nmol）. The response of MAP to ganglionic blockade with hexamethonium in conscious rats was performed to evaluate sympathetic activity. The renal sympathetic nerve activity and cardiac sympathetic afferent reflex were enhanced in adriamycin rats and the maximum depres- sor response of MAP induced by hexamethonium was significantly greater in adriamycin rats than that in control rats. Bilateral PVN microinjection of angiotensin II （Ang II） caused larger responses of the cardiac sympathetic afferent reflex, baseline renal sympathetic nerve activity and MAP in adriamycin rats than control rats. These re- sults indicated that both sympathetic activity and cardiac sympathetic afferent reflex were enhanced and Ang II in the PVN was involved in the enhanced sympathetic activity and cardiac sympathetic afferent reflex in rats with adriamycin-induced heart failure.

Computed tomography-guided chemical renal sympathetic nerve modulation in the treatment of resistant hypertension: A case report

BACKGROUND Resistant hypertension(RH)has always been a difficult problem in clinical diagnosis and treatment.At present,there is no recognized safe and effective minimally invasive treatment.CASE SUMMARY An 80-year-old woman was admitted to hospital due to trigeminal neuralgia(TN).The patient had a history of RH for more than 10 years and her blood pressure(BP)was not well-controlled.Before the treatment for TN,we decided to perform chemical renal sympathetic denervation with ethanol in the Pain Department of our hospital.One year after the operation,she stopped taking antihypertensive drugs,and her BP was satisfactorily controlled within 4 years after surgery.CONCLUSION Computed tomography-guided chemical renal sympathetic modulation may be a feasible method for the treatment of RH.