Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 May 31;8(5):35-41.
doi: 10.3941/jrcr.v8i5.1407. eCollection 2014 May.

Symptomatic vertebral artery loop: a case report and review of literature

Ahmed Doweidar  1 , Saeed Al-Sayed  2 , Salwa Al-Kandery  1
Affiliations
Review

Symptomatic vertebral artery loop: a case report and review of literature

Ahmed Doweidar et al. J Radiol Case Rep. .

Abstract

Vertebral artery loop formation is a rare anatomical variant capable of causing bony erosion, encroachment on cervical neural foramen, neurovascular compression, or vertebrobasilar insufficiency. Health professionals should keep the diagnosis of vertebral artery loop formation in mind, especially when the plain radiograph of the cervical spine shows enlargement of the intervertebral foramen. If overlooked, serious complications like vertebral artery injury may occur during surgery or vertebrobasilar angiography, as well as cerebrovascular stroke during transforaminal cervical epidural steroid injections. This case report aims at increasing the awareness of both clinicians and radiologists of this entity as a known rare cause of cervical radiculopathy. In suspected cases, Magnetic resonance imaging & Magnetic resonance angiography should always be the first choice in this regard.

Keywords: Vertebral artery loop formation; cervical radiculopathy; magnetic resonance angiography; neurovascular compression.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A 70-year-old woman with Vertebral Artery Loop Formation. Axial non contrast CT scan of the cervical spine obtained at the level C5-6 shows soft tissue density within the widened left intervertebral foramen and erosion of the adjacent bony structures (arrows in A and B). (Protocol: Philips Brilliance 16 multislice, KV 140, mA range 280–715, slice thickness 1.25 mm)
Figure 2
Figure 2
A 70-year-old woman with Vertebral Artery Loop Formation. T1-weighted axial magnetic resonance image without contrast shows a signal-void vascular structure in the widened left C5-6 intervertebral foramen (arrow). (Protocol: GE Signa HD 1.5 T, TE 19 ms, TR 500 ms)
Figure 3
Figure 3
A 70-year-old woman with Vertebral Artery Loop Formation. T2-weighted axial magnetic resonance image without contrast shows a signal-void vascular structure in the right C4-5 intervertebral foramen (arrow). (Protocol: GE Signa HD 1.5 T, TE 107 ms, TR 3820 ms)
Figure 4
Figure 4
A 70-year-old woman with Vertebral Artery Loop Formation. T2-weighted sagittal magnetic resonance images without contrast show a signal-void vascular structure in the widened left C5-6 intervertebral foramen (arrows in A and B). (Protocol: GE Signa HD 1.5 T, TE 107 ms, TR 3820 ms)
Figure 5
Figure 5
A 70-year-old woman with Vertebral Artery Loop Formation. T2-weighted coronal magnetic resonance images without contrast show a signal-void vascular structure in the left C5-6 intervertebral foramen (arrows in B and C), and another similar structure in the right C4-5 intervertebral foramen (arrows in A and B). (Protocol: GE Signa HD 1.5 T, TE 107 ms, TR 3820 ms)
Figure 6
Figure 6
A 70-year-old woman with Vertebral Artery Loop Formation. Three Dimension Time Of Flight Magnetic Resonance Angiography without contrast (3D TOF MRA) with Maximum Intensity Projection (MIP) reconstruction shows bilateral vertebral artery loop formation (VALF) in C5-6 left intervertebral foramen and C4-5 right intervertebral foramen (arrows). (Protocol: GE Signa HD 1.5 T, TE 2.8 ms, TR 23 ms, FA 25, NEX =1)
See this image and copyright information in PMC

References

    1. Kim HS, Lee JH, Cheh G, Lee SH. Cervical Radiculopathy Caused by Vertebral Artery Loop Formation : A Case Report and Review of the Literature. J Korean Neurosurg. 2010;Soc 48:465–468. - PMC - PubMed
    1. Epstein NE, Silvergleid R. Magnetic resonance angiographic diagnosis of ecstatic vertebral artery. J Spinal Disord. 1995;8:308–310. - PubMed
    1. Hadley LA. Tortuosity and deflection of the vertebral artery. Am J Roentgenol Radium Ther Nucl Med. 1958;80:306–312. - PubMed
    1. Paksoy Y, Levendoglu FD, Ogün CO, Ustün ME, Ogün TC. Vertebral artery loop formation : a frequent cause of cervicobrachial pain. Spine (Phila Pa 1976) 2003;28:1183–1188. - PubMed
    1. Oga M, Yuge I, Terada K, Shimizu A, Sugioka Y. Tortuosity of the vertebral artery in patients with cervical spondylotic myelopathy. Risk factor for the vertebral artery injury during anterior cervical decompression. Spine (Phila Pa 1976) 1996;21:1085–1089. - PubMed

MeSH terms

LinkOut - more resources