Teaching NeuroImages: intermittent symptomatic occlusion of the vertebral artery caused by a cervical osteophyte.
A 77-year-old man presented with 2 episodes of waking up with symptoms of vertebrobasilar ischemia (figure, A and B) within 6 months. A CT angiogram showed narrowing of the right vertebral artery due to extrinsic compression by an osteophyte of the superior articular process of the fourth cervical vertebra, compromising the foramen transversarium (figure, C and D). Dynamic angiography demonstrated intermittent vascular occlusion associated with head turning (figure, E-G). After recurrence, surgical decompression of the vertebral artery was performed. Extrinsic compressions of the vertebral artery is rare.(1) The most frequent signs are those of vertebrobasilar insufficiency. Surgical treatment has been proposed when conservative management fails.(1).
Department of Neurology, Montpellier University Hospital, Montpellier, France. i-mourand@chu-montpellier.fr
Isabelle
I
Mourand
Souhayla
S
Azakri
Guillaume
G
Boniface
Alain
A
Bonafé
Igor Lima
IL
Maldonado
D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology; D006801:Humans; D008297:Male; D059906:Neuroimaging / Q000379:methods*; D054850:Osteophyte / Q000150:complications*; D011859:Radiography; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000209:etiology*