Symptomatic medulla compression by vertebral artery

Increased prevalence of vertebrobasilar dolichoectasia in Parkinson's disease and its effect on white matter microstructure and network

This study aimed to investigate the prevalence of vertebrobasilar dolichoectasia (VBD) in Parkinson's disease (PD) patients and analyze its role in gray matter changes, white matter (WM) microstructure and network alterations in PD. This is a cross-sectional study including 341 PD patients. Prevalence of VBD in these PD patients was compared with general population. Diffusion tensor imaging and T1-weighted imaging analysis were performed among 174 PD patients with or without VBD. Voxel-based morphometry analysis was used to estimate gray matter volume changes. Tract-based spatial statistics and region of interest-based analysis were used to evaluate WM microstructure changes. WM network analysis was also performed. Significantly higher prevalence of VBD in PD patients was identified compared with general population. Lower fractional anisotropy and higher diffusivity, without significant gray matter involvement, were found in PD patients with VBD in widespread areas. Decreased global and local efficiency, increased hierarchy, decreased degree centrality at left Rolandic operculum, increased betweenness centrality at left postcentral gyrus and decreased average connectivity strength between and within several modules were identified in PD patients with VBD. VBD is more prevalent in PD patients than general population. Widespread impairments in WM microstructure and WM network involving various motor and nonmotor PD symptom-related areas are more prominent in PD patients with VBD compared with PD patients without VBD.

A case of vertebral artery compression syndrome mimicking primary lateral sclerosis

PURPOSE

Vertebral artery compression syndrome (VACS) is an under-recognised condition that may be misdiagnosed as motor neuron disease. We report a case presenting features initially suggestive of primary lateral sclerosis (PLS) but later found to be VACS.

CASE PRESENTATION

A 65-year-old man with hypertension was referred to our neurology department in the suspect of PLS. He presented with a 10-year history of involuntary jerk of the left lower limb, which ascended to the left upper limb 9 years later. He also developed intermittent painful spasms with a tendency to drag his left leg. His symptoms fluctuated with blood pressure. Neurological examination revealed upper motor neuron signs without lower motor neuron or sensory involvement. Electrophysiology studies were unremarkable. Brain MRI disclosed the left side of medulla oblongata was compressed by the tortuous left vertebral artery. Diffusion tensor tractography confirmed the corresponding corticospinal tract disruption. He was diagnosed with VACS and treated with antispasmodic medications and antihypertensive drugs.

CONCLUSIONS

VACS should be considered into the differential diagnoses of PLS. A thorough clinical assessment and careful interpretation of brain MRI with advanced diffusion neuroimages can help confirm the diagnosis.

Non-Dolichoectatic Vertebral Artery Compression of the Medulla: A Comprehensive Literature Review

OBJECTIVE

Vertebral artery compression of the medulla is a rare vascular finding that causes a variety of clinical presentations, from asymptomatic to neurological disability. This article presents the largest literature review to date on medullary compression of the vertebral arteries.

METHODS

An English literature search was performed using the PubMed database and the keywords vertebral artery tortuosity, vertebral artery compression, and medullary compression.

RESULTS

A comprehensive literature search yielded 68 patients (57% male) with medullary compression by an intracranial vertebral artery (ICVA). The left side of the medulla was compressed in 44, the right side in 19, and bilateral in 7. The most common clinical symptom was weakness - 26 patients (36%) - 6 had quadriparesis and 6 had hemiparesis. 21 patients reported imbalance; 12 various sensory symptoms; 4 patients were asymptomatic.

CONCLUSIONS

Understanding the anatomy of the vasculature can help mitigate future debilitating stroke symptoms. Concrete guidelines for revascularization surgery in symptomatic patients may also be effective. Future studies are needed to further clarify the prevalence, natural history, vascular etiology, and treatment of this condition, including asymptomatic patients and the likelihood that they will develop further neurological signs and disability.

Progressive bulbar symptomatology due to vascular brainstem compression

Symptomatic brainstem compression from vertebral artery dolichoectasia is rare. There are no recognised diagnostic or treatment criteria to guide management of this disease. We report a case of medullary compression and cerebral ischaemia from an enlarged and tortuous vertebral artery. Our patient developed progressive dysphonia and dysphagia. Cerebral MRI revealed compression of the medulla oblongata by a right ectatic vertebral artery and a right occipital lobe infarct. Other causes of bulbar dysfunction were ruled out. He was treated with anticoagulation and underwent percutaneous endoscopic gastrostomy. We review selected literature on the presentation, diagnosis and management of this rare neurologic condition.

Medullary Compression Due to Ectatic Vertebral Artery-Case Report and Review of Literature

Medullary compression syndrome due to anomalous course of blood vessels is a rare disease most commonly seen in the adult population. The offending vessels causing this syndrome are mostly posterior inferior cerebellar artery or the vertebral artery. The symptoms of this syndrome vary from most common hypertension to various other neurologic deficits like hemiplegia, dysesthesia, and dysarthria. Intractable dizziness is a rare symptom of this disease. The definite management plan for this disease is microvascular decompression. We present our case of medullary compression syndrome which manifested as intractable dizziness. We describe our experience in the management of this patient as well as present a review of literature of this rare disease.