Vertebral artery dolichoectasia

Case contributed by Mahmoud Yacout Alabd , 22 Dec 2015
Diagnosis almost certain
Changed by Yusra Sheikh, 19 Feb 2020

Updates to Case Attributes

Age changed from 60-year-old to 60 years.
Body was changed:

Although the vestibular nuclei are predominantly located at the medulla which is seen here compressed by the dilated left vertebral artery, thethe findings are likely not related to the patient's symptom of vertigo. Since, since there is no underlying signal alteration of the compressed medulla and no definite cranial nerve compression. Dolichoectasia is also a long standing process, while the patient's symptoms have started only 1 month prior to the exampresentation. Further more Furthermore, there is no associated neurological deficits or localizing symptoms which would be the case if the medullary compression was significant enough to affect the corticospinal tracts that are even located more anterior and closer to the abnormal artery than the vestibular nuclei. 

The V4 segment of the left VA is dominant (the right side could not be identified) with tortuous course and above normal caliber of 5.5 mm. Bright signal is also seen within the artery lumen on filtered phase SWI, which is likely reflects underlying atherosclerotic calcifications, since this MRI sequence has the ability to differentiate between substances with paramagnetic and diamagnetic effect, hence differentiating between calcium and iron contents. 

  • -<p>Although the vestibular nuclei are predominantly located at the medulla which is seen here compressed by the dilated left vertebral artery, t<span style="line-height:23.1111px">he findings are likely not related to the patient's symptom of vertigo.</span><span style="line-height:1.6"> S</span><span style="line-height:1.6">ince there is no underlying signal alteration of the compressed medulla and </span><span style="line-height:1.6">no definite cranial nerve compression</span><span style="line-height:1.6">. <a title="Dolichoectasia" href="/articles/dolichoectasia-1">Dolichoectasia </a>is also a long standing process, while the patient's symptoms have started only 1 month prior to the exam. Further more, there is no associated neurological deficits or localizing symptoms which would be the case if the medullary compression was significant enough to affect the corticospinal tracts that are even located more anterior and closer to the abnormal artery than the vestibular nuclei. </span></p><p>The V4 segment of the left VA is dominant (the right side could not be identified) with tortuous course and above normal caliber of 5.5 mm. Bright signal is also seen within the artery lumen on filtered phase SWI, which is likely reflects underlying atherosclerotic calcifications, since this MRI sequence has the ability to differentiate between substances with paramagnetic and diamagnetic effect, hence differentiating between calcium and iron contents. </p>
  • +<p>Although the vestibular nuclei are predominantly located at the medulla which is seen here compressed by the dilated left vertebral artery, the findings are likely not related to the patient's symptom of vertigo, since there is no underlying signal alteration of the compressed medulla and no definite cranial nerve compression. <a href="/articles/dolichoectasia-1">Dolichoectasia </a>is also a long standing process, while the patient's symptoms have started only 1 month prior to presentation. Furthermore, there is no associated neurological deficits or localizing symptoms which would be the case if the medullary compression was significant enough to affect the corticospinal tracts that are even located more anterior and closer to the abnormal artery than the vestibular nuclei. </p><p>The V4 segment of the left VA is dominant (the right side could not be identified) with tortuous course and above normal caliber of 5.5 mm. Bright signal is also seen within the artery lumen on filtered phase SWI, which likely reflects underlying atherosclerotic calcifications, since this MRI sequence has the ability to differentiate between substances with paramagnetic and diamagnetic effect, hence differentiating between calcium and iron contents. </p>

Systems changed:

  • Head & Neck

Updates to Study Attributes

Findings was changed:

Dolichoectasia of the V4 segment of the left vertebral artery. 

The left abducent nerve has the most intimate relation to the dilated artery, however no compression is seen on oblique MPR T2 image.

Bright signal seen within the left VA on filtered phase SWI, suggesting underlying atherosclerotic calcification.

Indentation and compression to the medulla and cervico-medullary junction by the dilated tortuous vessel.

Dilated V4 segment of the left VA reaching 5.5 mm.

Images Changes:

Image Annotated image (Oblique heavily weighted T2) ( update )

Description was removed:
The left Abducent nerve has the most intimate relation to the dilated artery, however no compression is seen on oblique MPR T2 image.

Image Annotated image (Phase filtered SWI) ( update )

Description was removed:
Bright signal seen within the left VA on filtered phase SWI, suggesting underlying atherosclerotic calcification.

Image Annotated image ( update )

Description was removed:
Indentation and compression to the medulla and cervico-medullary junction by the dilated tortuous vessel.

Image Annotated image ( update )

Description was removed:
Dilated V4 segment of the left VA reaching 5.5 mm.

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