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924 - Cervical twists and turns: a vascular cause of pain

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

JF

Joshua Fuller, BSA, BA

Medical Student
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States

Corresponding Author(s)

SK

Sanketh Kichena, DO

Resident Physician
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States

Co-Author(s)

AR

Aditya Raghunandan, MD

Attending Physician
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States

Case Diagnosis: Vertebral Artery Compression Syndrome secondary to vertebral artery dolichoectasia

Case Description: A 53-year-old male presented to a PM&R clinic with a chief complaint of neck pain that started a few years prior and gradually worsened since. During examination, his neck pain was aggravated by rightward head rotation and associated with dizziness, dysgeusia, and odynophagia. This prompted the consideration of a possible intracranial or vascular pathology. The cervical MRI was noted to have a right-sided vertebral artery anomaly; hence CTA head/neck and MRI brain were ordered for further evaluation. This showed a tortuous, ectatic right dominant vertebral artery compressing the ipsilateral medulla oblongata. He was referred to vascular neurosurgery, who made the diagnosis of vertebral artery compression syndrome due to vertebral artery dolichoectasia. He underwent successful surgical intervention to mobilize the vertebral artery away from the brainstem and alleviate the compression. However, at the 6-month post-op visit, he so far noted minimal improvement in his neck pain or dizziness.

Discussions: This is a case of an atypical finding of compressive vertebral artery dolichoectasia found in a patient who presented to a PM&R-based outpatient musculoskeletal and spine clinic, and it highlights the importance of maintaining a broad differential diagnosis with atypical presentations of radicular neck pain. It specifically demonstrates the importance of keeping cervical vascular anomalies in the differential diagnosis. In this encounter, a quality history and physical recognized uncommon associated symptoms, which led to the ordering of the appropriate imaging to guide further treatment options.

Conclusions: When evaluating neck pain, it is important to consider cervical vascular anomalies in the differential diagnosis. Obtaining a thorough history and physical can help make the appropriate diagnosis.