Cervical Compressive Myelopathy due to Anomalous Bilateral Vertebral Artery

A case of suspected canine multifocal cervical venous sinus thrombosis causing cervical myelopathy

A 10-year-old spayed female standard poodle was admitted for marked cervical pain. Magnetic resonance imaging (MRI) suggested cervical venous sinus thrombi. An excellent clinical response to clopidogrel and warfarin combination was achieved. Repeat MRI showed partial resolution of the thrombosis. The etiology of the thrombosis is suspected to be due to the previous long-term, chronic use of corticosteroids. To the authors' knowledge, this is the first case report with follow-up imaging of canine venous sinus thrombosis. This clinical case report may help practitioners recognize this condition as a possible differential diagnosis for cervical pain, and it provides important guidelines in the prognosis. This case report highlights the use of anticoagulant therapy for 14 wk leading to complete resolution of clinical signs and to partial resolution of the thrombus 5 wk into the treatment, based on comparative MRI. Key clinical message: To the authors' knowledge, this is the first report of suspected multiple cervical venous sinus thrombi that includes comparative imaging into the course of therapy. The aim of this report is to provide additional information for future guidance on the duration of venous sinus thrombosis therapy.

A case report of microvascular decompression for cervical myelopathy and radiculopathy caused by tortuous and abnormal bilateral vertebral artery

Background:

Tortuous/abnormal vertebral arteries (VAs) sometimes cause neurovascular compression syndromes (NVCs), such as trigeminal neuralgia, hemifacial spasm, and, rarely, myelopathy/radiculopathy. Abnormalities/tortuosity of the VA at the level of the atlas and axis are of particular note; these may be characterized by a persistent first intersegmental artery (PFIA) and C2 segmental type of VA. Herein, we report a 72-year-old male who presented with cervical myelopathy/radiculopathy due to bilateral tortuosity of the PFIA resulting in spinal cord compression at the craniocervical junction.

Case Description:

A 72-year-old male presented with cervical pain when turning his neck and progressive gait disturbance. The neurological examination demonstrated a moderate myeloradicular syndrome (Nurick Grade III). The magnetic resonance revealed compression of the medulla and spinal cord due to tortuosity of both dorsal VA at the C1 vertebral level. The three-dimensional computed tomography angiogram confirmed bilateral PFIA running medially. In addition, the left side of VA forms fenestration. Surgery through a C1 laminectomy and midline small suboccipital craniectomy, both VAs were transposed and tethered to the ipsilateral dura utilizing Aron Alpha and vinyl prostheses. In addition, a large vinyl prosthesis was inserted between both VAs to protect them from contacting the spinal cord. Following this decompressive procedure, the patient’s symptoms fully resolved, and he remains asymptomatic 10 years later exhibiting no recurrent vascular pathology.

Conclusion:

Microvascular decompression of anomalous VAs contributing to cord compression at the C1 level was safe and effective in a 72-year-old male.

Vertebral Artery Compression Syndrome

Objective: We aim to propose the term "vertebral artery compression syndrome" to describe a group of patients with a variety of clinical symptoms caused by vertebral artery compression of the medulla or spinal cord. Methods: We conducted the prospective case study in a university teaching hospital. Eleven patients who fulfilled the diagnostic criteria of vertebral artery compression syndrome and 22 age- and sex- matched controls were recruited. Clinical presentation and radiological findings of patients with vertebral artery compression syndrome were assessed and recorded. The basilar artery diameter was measured at the midpons level on T2 weighted MR images and compared between both groups. Results: Medullary compression was observed in 10 of 11 patients. The most common clinical presentation is dizziness, vertigo, imbalance, or ataxia followed by limb weakness. Cervical spinal cord compression was observed in one patient who presented with neck pain and left leg weakness. The mean basilar artery diameter was similar between patients and controls (3.95 ± 0.41 vs. 3.81 ± 0.43 mm). Conclusions: Vertebral artery compression of medulla and spinal cord may cause various clinical symptoms. Future studies are needed to further clarify the prevalence, natural history and treatment of this condition.

High Cervical Spinal Cord Compression Associated with Anomaly of Bilateral Vertebral Arteries

BACKGROUND

Anomalies of the vertebral arteries are rare and usually detected incidentally. However, very rarely, they can manifest with clinical symptoms. We describe such a symptomatic case of high cervical spinal cord compression associated with persistent C2 segmental arteries.

CASE DESCRIPTION

A 67-year-old man presented with a 5-year history of worsening left-sided weakness and gait disturbance. Magnetic resonance imaging, 3-dimensional computed tomography, and digital subtraction angiography revealed anomalous courses of the vertebral arteries, which compressed the cervical spinal cord at the C1 level from both sides. Interestingly, the left vertebral artery had fenestration, which supposedly reflected that the intradural paramedian longitudinal axis had developmentally persisted until more distally on the left. Microvascular decompression was performed to transpose the offending vertebral arteries. With vascular tapes made of polyglycolic acid sheets and fascia, the vertebral arteries compressing the cervical spine were anchored to the dura mater of the vertebral arch. This maneuver effectively relieved the neurovascular conflict created by the bilateral anomalous vertebral arteries, and the patient's myelopathy improved after surgery. To our knowledge, this is the first report to clearly demonstrate this combination of vertebral artery anomalies causing clinical symptoms and its successful treatment by microvascular decompression.

CONCLUSIONS

Transposition of the vertebral artery by anchoring to the dura mater of the vertebral arch could be an effective and safe option for these disease conditions.