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Table of Contents    
NEUROIMAGE
Year : 2016  |  Volume : 64  |  Issue : 1  |  Page : 195-196

Brainstem dysfunction due to compression by megadolicho-vertebral arteries


1 Department of Neurology, Rouen University Hospital and University of Rouen, France
2 Department of Neurophysiology, Rouen University Hospital and University of Rouen, France

Date of Web Publication11-Jan-2016

Correspondence Address:
Ozlem Ozkul-Wermester
Department of Neurology, Rouen University Hospital, 76031 Rouen Cedex
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.173666

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How to cite this article:
Ozkul-Wermester O, Lebas A, Triquenot-Bagan A. Brainstem dysfunction due to compression by megadolicho-vertebral arteries. Neurol India 2016;64:195-6

How to cite this URL:
Ozkul-Wermester O, Lebas A, Triquenot-Bagan A. Brainstem dysfunction due to compression by megadolicho-vertebral arteries. Neurol India [serial online] 2016 [cited 2019 Aug 25];64:195-6. Available from: http://www.neurologyindia.com/text.asp?2016/64/1/195/173666


A 58-year-old man presented with sudden onset left-sided sensorineural hearing loss in 2011. The patient had pre-existing arterial hypertension. Brain magnetic resonance imaging (MRI) with angiographic sequences demonstrated vertebral and basilar megadolichoectasia with aneurysmal dilatation of the intracranial portions of the vertebral arteries [Figure 1]. A floating thrombus of the left vertebral artery probably led to the internal auditory artery occlusion without vertebrobasilar infarction. He never regained his hearing. Assessment for Fabry disease did not reveal any abnormality. The follow-up magnetic resonance angiography showed aggravation of these vascular abnormalities causing progressive extra-axial cranial nerve compression [Figure 2]. The patient developed swallowing dysfunction and dysarthria, but with no evidence of stroke despite the presence of the partially thrombosed left vertebral artery aneurysm. The swallowing dysfunction led to respiratory distress and the patient required admission to an intensive care unit. Percutaneous endoscopic gastrostomy and tracheostomy were performed and then he was directed to a rehabilitation center.
Figure 1: Gadolinium enhanced T1-weighted brain MRI showing vertebral aneurysmal dilatations (2011)

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Figure 2: Follow-up gadolinium enhanced T1-weighted MRI showing vertebral aneurysmal dilatations (2015)

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Endovascular intervention had been considered but was not performed since the arterial dilatation was too long to be treated, and stenting would have resulted in a significant risk of vertebrobasilar ischemia [Figure 3]. Megadolichovertebral and basilar arteriopathy are generally attributable to arterial hypertension. Surgery for microvascular decompression or endovascular treatment of the aneurysm have been proposed, but literature on this subject is sparse and consists only of a few case reports.[1]
Figure 3: Three dimensional reconstruction of vertebral and basilar arteries (2015)

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Skrap M, Vindigni M, Tuniz F. Bulbar Compression by the Vertebral Artery: Four Atypical Cases. Cureus 3:e28.  Back to cited text no. 1
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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