Vertebral artery ectasia
Updates to Article Attributes
Vertebral artery ectasia refers to an abnormal dilatation of the vertebral artery. It is also known as a Dolicoarterial loop (of Danziger).
Pathology
Vertebral arterial wall thinning and elongation (usually age-related); majority are unilateral.
Occlusion of the carotid arteries (bilaterally) may precipitate vertebral artery dilatation as a compensatory mechanism for maintaining cerebral perfusion 1.
Clinical presentation
Symptoms occur due to radicular compression or pathologic fracture (rare) from extensive bone erosion.
Generally patient presents with headache, dizziness, sub occipital pain,nausea and vomiting.
Radiographic features
Plain film
- enlargement of the transverse foramen
- erosion of pedicle and posterolateral vertebral body expanding the intervertebral foramen
- extrinsic bone erosion seen in the midcervical segments, usually at C4-C5 level (Hadley’s erosive defect)
CT
better visualisation of plain film findings
MRA
Best method to confirm the presence of a dolicoectatic loop or dolicoarterial loop.
Differential diagnosis
Consider other vascular causes of pedicle erosion:
- arteriovenous malformation
- pseudoaneurysm
- aortic coarctation
- subclavian steal syndrome
- carotid obstruction
-<li>extrinsic bone erosion seen in the midcervical segments, usually at C4-C5 level</li>- +<li>extrinsic bone erosion seen in the midcervical segments, usually at C4-C5 level (<strong><em>Hadley’s </em></strong>erosive defect)</li>
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