Cale Melham, MD
Resident Physician
University of Toledo
Sylvania, Ohio, United States
William Brady, DO
Physician
Peachtree Orthopedics
Atlanta, Georgia, United States
Left C7 nerve root compression from vertebral artery dolichoectasia
Case Description: A 48-year-old male presented with left upper extremity weakness, burning, and aching for several weeks. Initially, his symptoms were mild and intermittent in only the 3rd through 5th digits of his left hand. Over time, they worsened, became constant, and spread to his lateral forearm.
On physical examination, there was no Hoffman's sign or clonus. Spinal reflexes were 2+ bilaterally. Sensory testing revealed hyperalgesia in the left C7 dermatome.
Electromyography showed positive sharp waves in the left triceps and pronator teres. MRI of the cervical spine revealed dolichoectasia of the left vertebral artery, extending into the left C6-7 neuroforamen and compressing the left C7 nerve root. Treatment with gabapentin, analgesics, and a C7-T1 interlaminar epidural steroid injection were unsuccessful.
Discussions:
The patient was diagnosed with left C7 nerve root compression caused by the left vertebral artery aberrant course. Given conservative treatment failure, surgical referral was made. He underwent decompression of the left C7cervical root via anterior approach transverse foraminotomy. Postoperatively, he reported improvement in his symptoms and started occupational therapy.
Cervical nerve root compression caused by vertebral artery dolichoectasia is a rare phenomenon without clear treatment standards, making diagnosis and management challenging. Unlike vertebrobasilar dolichoectasia, a similar vascular pathology which typically affects the brainstem, this condition involves compression at the cervical level.
Conclusions:
This case demonstrates the importance of considering vertebral artery dolichoectasia as a possible cause of cervical radiculopathy, especially after conventional treatments have failed. In addition, it contributes to the limited body of evidence regarding the management of this rare diagnosis, offering valuable insights into both clinical presentation and therapeutic outcomes.
