Vertebral Artery Dissection as a Cause of Cervical Radiculopathy
A 43-year-old woman awoke with left cervical discomfort 10 days before presentation. The discomfort radiated to the trapezius and scapular region, and was aggravated by neck movement. 4 days after awakening with cervical discomfort, she noted the inability to abduct her left arm. In retrospect, she recalled mild left upper cervical discomfort on neck rotation to the left while reversing her car about 4 days before the symptoms began. On examination, she had weakness involving the left deltoid, supraspinatus, infraspinatus and biceps muscles (4/5), with milder weakness of left forearm pronation and supination (4+/5). The left biceps reflex was absent and the left brachioradialis reflex reduced. The remainder of the neurological examination including left upper limb sensory examination and cranial nerve examination was normal.\nCervical MRI revealed an intramural haematoma in the left vertebral artery from mid-C7 to C2 (, ). MR-angiogram (MRA) demonstrated spiral arrangement of intramural methaemoglobin and irregularity of the vessel lumen from C2-C6 (). No intimal flap was evident. The vessel wall haematoma was seen to compress the left C5 and C6 nerve roots. Cranial MRI was normal. An electromyogram performed 11 days after her weakness began revealed acute denervation consistent with an acute left C5/6 radiculopathy. The lateral antebrachial sensory response and other sensory studies were normal. Nerve conduction studies including median and ulnar F-wave responses were normal. She was treated with aspirin as an antiplatelet agent. Left upper limb power returned to normal after 2 months; repeat MRI/A showed recanalization of the vertebral artery with no residual abnormality or nerve root compression.