title: Anatomical variation of the vertebral artery clinically mimicking myasthenia gravis.
abstract: Cranial nerve palsy, most commonly trigeminal, abducens, or facial, caused by compression of an ectatic or elongated intracranial artery is a well-known phenomenon. Symptoms of brain stem compression by an abnormal artery have rarely been reported (Tomasello et al. Neurosurgery 56(suppl 1):117-124, 2005). The authors present a 59-year-old woman with intermittent ptosis of the right eye, diplopia and swallowing disturbances, enhanced after physical effort, implying myasthenia gravis. Typical diagnostic procedures, e.g. repetitive nerve stimulation tests, acetylcholine receptor antibodies level were within normal limit. Neurogenic changes from the orbicularis oculi muscle were found in EMG. MRI and angio-CT revealed anatomical variation of the vertebral artery (elongated and arcuate route), causing intermittent signs of brain stem lesion. We point out the similarity of the clinical symptoms of myasthenia gravis and vascular brain stem compression by abnormal vertebral artery. The two diseases require completely different therapeutic proceedings.
authors.affiliation: Department of Neurology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Ejma
authors.forename: Magdalena
authors.initials: M
authors.lastname: Koszewicz
authors.forename: Ryszard
authors.initials: R
authors.lastname: Podemski
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Marianska
authors.forename: Slawomir
authors.initials: S
authors.lastname: Budrewicz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Turek
mesh_terms: D001763:Blepharoptosis / Q000209:etiology; D001767:Blinking / Q000187:drug effects; D003937:Diagnosis, Differential; D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000002:abnormalities* / Q000473:pathology*