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Progressive bulbar symptomatology due to vascular brainstem compression.
Osman Younus1, Timothy Hampton2,3, Eli Silber4,5
1Neurology, Lewisham and Greenwich NHS Trust, London, UK osman.younus@nhs.net.
BMJ Case Reports
|March 16, 2021
Summary
Vertebral artery dolichoectasia can cause rare brainstem compression, leading to symptoms like dysphonia and dysphagia. This case highlights the need for clear diagnostic and treatment guidelines for this neurologic condition.
Area of Science:
- Neurology
- Vascular Neurology
Background:
- Vertebral artery dolichoectasia is a rare condition characterized by abnormal enlargement and tortuosity of the vertebral arteries.
- Symptomatic brainstem compression from this condition is exceptionally uncommon, lacking established diagnostic and treatment protocols.
Observation:
- A patient presented with progressive dysphonia and dysphagia, indicative of bulbar dysfunction.
- Cerebral MRI confirmed compression of the medulla oblongata by an ectatic right vertebral artery and identified a right occipital lobe infarct.
Findings:
- The patient's symptoms were attributed to medullary compression and cerebral ischemia caused by the enlarged and tortuous vertebral artery.
- Other potential causes of bulbar dysfunction were systematically excluded.
Implications:
- This case underscores the importance of considering vertebral artery dolichoectasia in the differential diagnosis of unexplained bulbar symptoms.
- The management involved anticoagulation and percutaneous endoscopic gastrostomy, suggesting potential therapeutic avenues.
- Further research is warranted to establish diagnostic criteria and treatment guidelines for symptomatic vertebral artery dolichoectasia.
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