| Summary points: | A 36-year-old male with a 3-year history of arterial hypertension presents with severe suboccipital headache, vomiting, and frequent drop attacks. Family history, physical examination, laboratory tests, contrast-enhanced brain MRI, and CT angiography are described, with images; surgical management and outcome are summarised. The authors discuss the causes of secondary hypertension, including neurogenic hypertension caused by rostral ventrolateral medullary compression, providing a review of the literature. |