Age / Sex : 65 / M

Cervical radiculopathy caused by vertebral artery loop formation

Discussion

Findings:

Sagittal T2-weighted MR images demonstrate tortuous right vertebral artery at C5-6, with widening of intervertebral foramen.

On coronal reformatted and volume rendering image of CT vertebral arteriography show tortuous vertebral arteries, right at C5-6 and left at C6-7

Differential Diagnosis:

Diagnosis: Vertebral artery loop syndrome

           Cervical radiculopathy caused by vertebral artery loop formation

Discussion:

A rare cause of cervical radiculopathy, usually asymptomatic

-       Mechanism: cervical spondylotic changes, hemodynamic stress, narrowing of the disc space

Findings

-       Erosion of adjacent bony structures with sharp and sclerotic margins induced by high pulsatile arterial pressure

-       Enlargement of the affected intervertebral neural foramen

Symptoms

-       Higher level: dysphagia, glossopharyngeal neuralgia, Horner’s syndrome, Neurogenic hypertension, occipital neuralgia, sensation of pharyngeal mass, spasmodic torticollis

-       Lower level: cervico-brachial neuralgia

Treatment

-       Microvascular decompression

-       Conservative care

References:

1.     Ganjyusufoglu K, Yasuda M, Marsella M, Di Emidio P, George B. Cervical radiculopathy caused by vertebral artery loop formation: Multislice computed tomography angiography findings. J Comput Assist Tomogr. 2005;29(1):133-135

2.     Kim HS, Lee JH, Cheh G, Lee SH. Cervical radiculopathy caused by vertebral artery loop formation: a case report and review of the literature. J Korean Neurosurg Soc. 2010; 48(5):465-468