Rostral ventrolateral medulla
The rostral ventrolateral medulla (RVLM), also known as the pressor area of the medulla, is a brain region that is responsible for basal and reflex control of sympathetic activity associated with cardiovascular function. Abnormally elevated sympathetic activity in the RVLM is associated with various cardiovascular diseases, such as heart failure and hypertension. The RVLM is notably involved in the baroreflex.
It receives inhibitory GABAergic input from the caudal ventrolateral medulla (CVLM). The RVLM is a primary regulator of the sympathetic nervous system; it sends catecholaminergic projections to the sympathetic preganglionic neurons in the intermediolateral nucleus of the spinal cord via reticulospinal tract.
Physostigmine, a choline-esterase inhibitor, elevates endogenous levels of acetylcholine and causes a rise in blood pressure by stimulation of the RVLM. Orexinergic neurons from the lateral hypothalamus output in the RVLM.
- Mischel NA, Subramanian M, Dombrowski MD, Llewellyn-Smith IJ, Mueller PJ (May 2015). "(In)activity-related neuroplasticity in brainstem control of sympathetic outflow: unraveling underlying molecular, cellular, and anatomical mechanisms". Am. J. Physiol. Heart Circ. Physiol. 309 (2): H235–43. doi:10.1152/ajpheart.00929.2014. PMC 4504968. PMID 25957223.
Specifically, we focus on changes in the rostral ventrolateral medulla (RVLM), a critical brain region for basal and reflex control of sympathetic activity. The RVLM is implicated in elevated sympathetic outflow associated with several cardiovascular diseases including hypertension and heart failure
- Medullary pressor area: site of action of intravenous physostigmine