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Sixth cranial nerve palsy caused by compression from a dolichoectatic vertebral artery
Ying Zhu1, Keith Thulborn, Kimberlee Curnyn
1Abraham Lincoln School of Medicine, University of Illinois, Chicago, IL 60612, USA.
Summary
A cyclist developed sixth cranial nerve palsy after exercise. Imaging revealed a dolichoectatic vertebral artery compressing the nerve, suggesting exercise-induced blood flow changes precipitated the palsy.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Cranial nerve palsies can arise from vascular compression.
- Dolichoectatic basilar artery compression of cranial nerves is well-documented.
- Compression by dolichoectatic vertebral arteries is less recognized.
Observation:
- A 68-year-old man presented with persistent left sixth cranial nerve palsy post-bicycle trip.
- High-resolution 3 Tesla MRI was performed.
- The MRI revealed a dolichoectatic vertebral artery compressing the left sixth cranial nerve at its root exit zone on the pons.
Findings:
- The vertebral artery was dolichoectatic and compressing the sixth cranial nerve.
- The compression occurred at the nerve's root exit zone against the pons.
- Aerobic exercise may have increased blood flow, precipitating the palsy.
Implications:
- This case highlights dolichoectatic vertebral artery as a potential cause of sixth nerve palsy.
- Prolonged aerobic exercise might trigger neurovascular compression symptoms.
- Recognizing vertebral artery compression is crucial for diagnosing specific cranial nerve palsies.