Fastigial Pressor Response Observed during an Operation on a Patient with Cerebellar Bleeding–An Anatomical Review and Clinical Significance

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Abstract
The fastigial pressor response (FPR) consists of an abrupt rise in blood pressure and tachycardia with hyperpneic response. The FPR is an important sign in posterior fossa surgery for respiration in postoperative patients. The authors experienced a distinct pressor, tachycardiac, and hyperpneic response elicited when controlling bleeding using a bipolar coagulator forceps at the subfastigial white matter in a 72-year-old man with cerebellar hemorrhage. This response was confirmed by bipolar electrodes, which produced a weak current under deeper anesthesia by increasing the concentration of enflurane. The postoperative course of this patient was uneventful. A FPR was suggested to be mediated by axons passing between the nucleus fastigii and the fourth ventricle. These commissural fibers mediating the FPR were suggested to be countercurrent efferent pathways from both sides of the nucleus parabrachialis lateralis, located at the dorsolateral corner of the rostral pons. The authors conclude that the partial destruction of the subfastigial commissural fiber bundle did not result in permanent respiratory deficit. Fatal respiratory disturbance might be anatomically suggested by completely cutting off this fiber bundle.