Vertebral artery loop causing radiculopathy

Case contributed by Dr Michał Czerny

Presentation

A 65 year old female patient showed up for an MRI scan with symptoms of left arm radiculopathy. Unspecific, speckled decrease in bone density of vertebral bodies was described on CT which was indication for MRI evaluation (CT report also denoted C3/C4 disc degeneration with possible disc protrusion).

Patient Data

Age: 65
Gender: Female
Modality: MRI

There are bilateral vertebral artery loops at the level of C3/C4 disc space with protrusion into the neural canal and possible nerve root impingement. 

Vertebral arteries are asymmetrical with left dominant - left vertebral artery encroaches a vast majority of the neural canal volume with high possibility of left sided C4 nerve roots compression. 

The contralateral signs are similar although right vertebral artery is significantly smaller with a lesser possibility of nerve roots compression. 

Additionally mild spondyloarthrosis is visible with some multilevel disc degeneration starting from C2 up to C6 without nerve roots or spinal cord compression. 

Case Discussion

This case is a classic presentation of a rare entity of vertebral artery loop causing radiculopathy. Vertebral artery loop formation can also cause bony erosions or vertebrobasillar insufficiency, which are more frequent. A good initial prognostic sign in classic radiography is neural foramen enlargement, which was not seen in this case and could cause a possible misdiagnosis. 

This is a very important cause of radiculopathy because of possible negative sequelae if missed on imaging i.e. cervical spine CT. Neurosurgical attempt of discectomy is likely to cause vertebral artery injury. 

In the final report we suggested CT angiography for confirmation (unfortunately further history is unknown as this was an outsourced examination for a patient treated in a different hospital). 

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Case Information

rID: 51937
Case created: 14th Mar 2017
Last edited: 17th Mar 2017
Systems: Spine, Vascular
Inclusion in quiz mode: Excluded

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