title: Resolution of intractable retching following mobilization of a dolichoectatic vertebral artery: case report of a unique brainstem-cranial nerve compression syndrome.
abstract: The authors present the case of a 53-year-old man who was referred with disabling retching provoked by left arm abduction. At the time of his initial evaluation, a cervical MRI study was available for review and revealed an anatomical variation of the ipsilateral juxtamedullary vertebrobasilar junction. After brain imaging revealed contact of the medulla by a dolichoectatic vertebral artery at the dorsal root entry zone of the glossopharyngeal and vagus nerves, the patient was successfully treated by microvascular decompression of the brainstem and cranial nerves. This case demonstrates how a dolichoectatic vertebral artery-a common anatomical variation that typically has no clinical consequence-should be considered in cases of cranial nerve dysfunction.
authors: Department of Neurosurgery, Penn State University College of Medicine, University Park Regional Campus, Mount Nittany Medical Center.
authors: Scott
authors: S
authors: Seaman
authors: Department of Neurosurgery, Penn State University College of Medicine, University Park Regional Campus, Mount Nittany Medical Center.
authors: Paul
authors: P
authors: Nelson
authors: Centre Diagnostic Imaging, Mount Nittany Medical Center, State College, Pennsylvania; and.
authors: Jacob
authors: J
authors: Alexander
authors: iSO-FORM, LLC, Ames, Iowa.
authors: Andrew
authors: A
authors: Swift
authors: Department of Neurosurgery, Penn State University College of Medicine, University Park Regional Campus, Mount Nittany Medical Center.
authors: James
authors: J
authors: Fick
mesh_terms: D001933:Brain Stem; D003391:Cranial Nerves; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods; D008875:Middle Aged; D009325:Nausea / Q000209:etiology*; D009408:Nerve Compression Syndromes / Q000150:complications* / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000601:surgery*
keywords: FIESTA = fast imaging employing steady state acquisition; NTS = nucleus tractus solitarius; PICA = posterior inferior cerebellar artery; brainstem; cranial nerve disorder; glossopharyngeal nerve; microvascular decompression; nucleus ambiguus; nucleus tractus solitarius; retching; vagus nerve; vascular disorders