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).
(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.
Appendix Authors
Footnotes
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