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Review
. 2021 Mar 15;14(3):e238323.
doi: 10.1136/bcr-2020-238323.

Progressive bulbar symptomatology due to vascular brainstem compression

Osman Younus  1 , Timothy Hampton  2   3 , Eli Silber  4   5 , George Dervenoulas  4
Affiliations
Review

Progressive bulbar symptomatology due to vascular brainstem compression

Osman Younus et al. BMJ Case Rep. .

Abstract

Symptomatic brainstem compression from vertebral artery dolichoectasia is rare. There are no recognised diagnostic or treatment criteria to guide management of this disease. We report a case of medullary compression and cerebral ischaemia from an enlarged and tortuous vertebral artery. Our patient developed progressive dysphonia and dysphagia. Cerebral MRI revealed compression of the medulla oblongata by a right ectatic vertebral artery and a right occipital lobe infarct. Other causes of bulbar dysfunction were ruled out. He was treated with anticoagulation and underwent percutaneous endoscopic gastrostomy. We review selected literature on the presentation, diagnosis and management of this rare neurologic condition.

Keywords: brain stem / cerebellum; cranial nerves; neuroimaging; neurology; stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Selected axial T2 images from the brain MRI study. There is an ectatic right vertebral artery (arrow) that displaces and compresses the medulla.
Figure 2
Figure 2
MRI diffusion weighted image. There is a small, recent right occipital lobe infarct near the midline and medially (arrow).
See this image and copyright information in PMC

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