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April 13, 2021; 96 (15) NeuroImages

Medulla Compression by Bilateral Aberrant Vertebral Artery With Mild Chiari Malformation

Zongli Han, Yanli Du, Peng Hu, Hongqi Zhang
First published February 26, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011752
Zongli Han
From the Peking University Shenzhen Hospital (Z.H.); School of Medical Technology and Nursing (Y.D.), Shenzhen Polytechnic; and Xuanwu Hospital of Capital Medical University (P.H., H.Z.), China.
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Yanli Du
From the Peking University Shenzhen Hospital (Z.H.); School of Medical Technology and Nursing (Y.D.), Shenzhen Polytechnic; and Xuanwu Hospital of Capital Medical University (P.H., H.Z.), China.
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Peng Hu
From the Peking University Shenzhen Hospital (Z.H.); School of Medical Technology and Nursing (Y.D.), Shenzhen Polytechnic; and Xuanwu Hospital of Capital Medical University (P.H., H.Z.), China.
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Hongqi Zhang
From the Peking University Shenzhen Hospital (Z.H.); School of Medical Technology and Nursing (Y.D.), Shenzhen Polytechnic; and Xuanwu Hospital of Capital Medical University (P.H., H.Z.), China.
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Medulla Compression by Bilateral Aberrant Vertebral Artery With Mild Chiari Malformation
Zongli Han, Yanli Du, Peng Hu, Hongqi Zhang
Neurology Apr 2021, 96 (15) 717-718; DOI: 10.1212/WNL.0000000000011752

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A 48-year-old woman developed progressive right lower extremity numbness and lancinating pain of right pharynx. T2-weighted MRI revealed a flow-void area that corresponded to the both aberrant vertebral arteries (persistent first intersegmental arteries) severely compressing and distorting the medulla oblongata and tonsilar herniation consistent with a mild Chiari malformation. Mild hydrocephalus was also noted with thinning of the corpus callosum and partial empty sella (figure).

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Figure T2-Weighted Imaging Showing Medulla Oblongata Being Deformed Into a Cloverleaf Shape

(A) Crowding of the cervicomedullary junction consistent with (B) a mild Chiari malformation (arrow) (note the thickness of the corpus callosum and partial empty sella) and (C) the bilateral vertebral arteries aberrantly entering the spinal canal below the atlas (red arrows).

Congestion at occipitocervical junction caused by bilateral vertebral artery compression may be related to Chiari malformation formation. This is an uncommon case of neurovascular compression,1 characterized by hemianesthesia, variant glossopharyngeal neuralgia, and Chiari malformation.2

Study Funding

No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Acknowledgment

The authors thank Fei Qiao, MD, and Xinxin Fan, MD for help with data collection.

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Table1

Footnotes

  • Go to Neurology.org/N for full disclosures.

  • © 2021 American Academy of Neurology

References

  1. 1.↵
    1. Koyama S
    , Lower medulla and upper cervical cord compression caused by bilateral vertebral artery: case illustration. J Neurosurg 2001;94(2 suppl):337.
    OpenUrlPubMed
  2. 2.↵
    1. Kobayashi T,
    2. Ogawa A,
    3. Kameyama M, et al
    . Chiari malformation with compression of the medulla oblongata by the vertebral arteries: case report. J Neurosurg 1992;77:307–309.
    OpenUrlPubMed

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