The periaqueductal grey area and control of blood pressure in neurodegeneration

Clin Auton Res. 2013 Aug;23(4):215-9. doi: 10.1007/s10286-013-0206-x. Epub 2013 Jun 30.


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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiparkinson Agents / adverse effects
  • Antiparkinson Agents / therapeutic use
  • Blood Pressure / physiology*
  • Blood Pressure Monitoring, Ambulatory
  • Deep Brain Stimulation
  • Electrodes, Implanted
  • Female
  • Humans
  • Middle Aged
  • Multiple System Atrophy / complications
  • Neurodegenerative Diseases / physiopathology*
  • Neurosurgical Procedures
  • Periaqueductal Gray / physiopathology*
  • Treatment Outcome
  • Tremor / etiology


  • Antiparkinson Agents