title: Congestion of epidural venous plexus secondary to vertebral artery occlusion mimicking a herniated cervical disc.
abstract: Vascular abnormalities or dissection of the vertebral artery are rare causes for cervical monoradiculopathy. We present the case of a 44-year-old female patient with a short history of radiculopathy of the right C5 root with radicular pain and a severe motor deficit. CT-imaging showed a hyperdense structure at the C4/C5 level suggesting a herniated disc. Because of the neurological deficit the patient was operated by a dorsal approach. Intraoperatively no herniated disc but only a congested epidural venous plexus was found. Postoperative MRI and angiography showed occlusion of the vertebral artery from C3 to C6 level probably due to dissection. The present case shows that a CT-study suggestive for a herniated disc can be misleading. Enlargement of the vertebral artery secondary to dissection or occlusion may lead to compression of the venous plexus which resembles disc material on CT-scan.
authors.affiliation: Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, D-81377 Munich, Germany. eberhard.uhl@med.uni-muenchen.de
authors.forename: Eberhard
authors.initials: E
authors.lastname: Uhl
authors.forename: Hartmut
authors.initials: H
authors.lastname: Brückmann
authors.forename: Claudia
authors.initials: C
authors.lastname: Goetz
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000601:surgery; D003937:Diagnosis, Differential; D004824:Epidural Space / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009460:Neurologic Examination; D010690:Phlebography; D011183:Postoperative Complications / Q000175:diagnosis; D011843:Radiculopathy / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014648:Varicose Veins / Q000175:diagnosis* / Q000601:surgery; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000601:surgery