Cervical Spinal Stenosis related to hypertension & Vertigo

[Joy7777]

I posted this question under the topic stroke since that is my bottom line concern; but Hypertension is part of my question as well as Vertigo.  I was diagnosed (via MRI) late in the 80's with cervical spinal stenosis; I didn't pay much attention to the Diagnosis, since I was having no problems then; however the MD said never to do neck exercises against resistance--that I do remember.  I don't recall what level of the C-spine; any medical records were not retained by me.  I was seeking Treatment for hand/arm paraasthesia at the time; carpel tunnel was diagnosed, treated with wrist splint effectively.  It was thought back body mechanics was the cause from biking, typing and delivering newspapers--the c-spinal stenosis was caught as a result of the carpel tunnel issue.
Now I am 60 y.o. and having episodes of vertigo & twice needed to go to the ER.  I have no medical insurance; so no extensive testing has been done.  I can't be certain, but suspect the vertigo was stimulated by body movements (painting and repetitive bending forward and standing) and neck strain (once from driving 21 hrs. straight shifting a floor stick-shift auto).   For the past few years I've been borderline pre-hypertensive 130/90 (otherwise normal for me is 110/75) & feel anxious and irritable when the BP is elevated which it always is with vertigo episodes.  I take no medications at all, but for tylenol extra strength sinus over the counter product for severe pounding headache at the occipital area (esp. when bending over) that accompanies the vertigo.  I usually awake in the night when the vertigo presents--a lovely way to wake up, if you haven't tried it + vomiting and nausea.  
I have suggested to MD at community clinic were I sought help once that I think c-spine stenosis causes all this; however this idea was poo-poo'd.  
QUESTION for Medical Expert:  Can Cervical Spinal Stenosis cause elevated BP and Vertigo?  And does this sound like a potential stroke about to happen?  

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history I can not comment on your risk of having a stroke in general, however I will try to provide you with some general information to answer your questions.

In response to your first question, cervical spine stenosis may contribute to elevated blood pressure by causing pain and discomfort which could then activate the part of the nervous system related to blood pressure regulation (“the sympathetic nervous system”) but it is unlikely to be the only cause of elevated blood pressure. Elevated blood pressure is very common and has many causes that should be ruled out based on history, examination, and some routine blood tests, but by far most often elevated blood pressure is what is called “essential”, or without a cause.

Regarding your vertigo, while neck problems can certainly contribute to vertigo, vertigo that occurs with changes in body position would more commonly be caused by other causes. Vertigo, or room-spinning type of dizziness, has many causes  that can generally be divided into inner ear problems and neurologic problems. Inner ear problems include one condition called Benign Paroxysmal Positional vertigo, in which brief attacks of dizziness are brought about by head position changes. This is best evaluated by a primary doctor or ENT (ear-nose-throat) specialist, and there is a simple treatment for it. Another cause of vertigo Meniere's disease, in which there is associated hearing loss. Attacks of vertigo in Meniere’s disease last longer, sometimes hours This is best evaluated by an ENT.

Neurologic causes of vertigo are various and include migraine, and certain disease in which several other features are present (not just isolated vertigo). There is a type of migraine variant called basilar migraine, the symptoms are hours of vertigo associated with nausea and headache and vision changes. If this is consistent with your symptoms, evaluation by a neurologist, and maybe a headache specialist, may be useful for you. A benign tumor that commonly grows in a specific area near the brain, a tumor called a schwanoma, can cause vertigo and associated hearing loss. Other neurologic causes, which are unlikely in your case given your history, include multiple sclerosis.

Narrowing of the arteries to the back of the brain can cause vertigo associated with other symptoms including double vision, difficulty speaking, sensory symptoms, and weakness. This is unrelated to cervical spine stenosis. The vertigo can occur spontaneously without triggers but is typically brought on by certain head positions and sometimes by drops in blood pressure. This narrowing is due to build up of plaque in the arteries. In patients with plaque build up in their arteries, there is a higher risk of stroke. Risk of plaque build up increases when a person smokes, has diabetes, high cholesterol, or high blood pressure that is poorly controlled. Evaluation of these arteries can be accomplished by a type of ultrasound called a transcranial Doppler (TCD) or a type of MRI called an MRA.

Evaluation by a general physician is advisable, he/she will be able to take a full history and determine what further testing is necessary and if you need further work-up such as MRI of the brain.

Thank you for the opportunity to answer your questions, I hope you find this information useful, good luck.

[Medavinci]

A related discussion, Can cervical stenosis of all C vertebrae cause hypertension was started.

[Joy7777]

Thank you very kindly for your time so generously offered in reply to my question.  There was an MRI from the 1987-88 time periods and a Cleveland Clinic Florida MD strongly suggested (due to the findings/spinal stenosis) that I never do neck exercises (she knew I liked to workout) and was quite emphatic.  I don’t remember what level of the C-spine and frankly then my neck felt fine at the time; it was only recently that I remember this.  I think it was at C1/C2; but have sent for the medical records to verify this.  I hope my current MD (family practice) & I will be able to secure them from back in 1987.  I think now that I am 60 y.o., there may be further compromises at that level due to possible arthritic changes.  In a chart of effects of spinal issues that I found, it indicates C1 areas are:  blood supply to the head, inner/middle ear, and sympathetic nervous system effecting headaches, nervousness, high blood pressure, migraines, and dizziness.  
C2 areas are:  eyes, sinuses effecting sinus trouble, fainting spells.
So if there is a compromise at these cervical levels, it would seem to make sense to me that what seems like my predisposition to ear issues, sinus-type headaches which are sometimes migraines I think, anxiety from no emotional cause and the feeling of fainting that comes with the vertigo could all starting at that level.  
Most every vertigo episode was preceded by some activity which would have strained or caused increased pressure on the neck.  My thought is that this and arthritic changes over the years, could now be putting additional pressure on a C1, C2 area that was already compromised long ago, increasing the high BP at those times, causing dizziness and near fainting, pressure in the head that is sinus-like.  I’d love to have another MRI done but have no medical insurance.  I am going to have some blood work done….what do I look for in the blood work results which could be an indication of the cause of the elevated BP?  Thank you.