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Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1494-1495

Curious Case of Kissing Vertebral Arteries With Left Vertebral Artery Dissection


Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Date of Submission12-Dec-2020
Date of Decision22-Dec-2020
Date of Acceptance06-Jul-2021
Date of Web Publication30-Oct-2021

Correspondence Address:
Apratim R Choudhury
Room -23, H-Block, Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329563

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How to cite this article:
Choudhury AR, Rajani H, Sharma A. Curious Case of Kissing Vertebral Arteries With Left Vertebral Artery Dissection. Neurol India 2021;69:1494-5

How to cite this URL:
Choudhury AR, Rajani H, Sharma A. Curious Case of Kissing Vertebral Arteries With Left Vertebral Artery Dissection. Neurol India [serial online] 2021 [cited 2021 Nov 28];69:1494-5. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1494/329563




We report a curious case of a 52-year-old gentleman with gradually progressive weakness of bilateral upper limb. Magnetic resonance imaging (MRI) of the cervical spine shows medialization of the bilateral vertebral artery flow voids causing compression of the cervical cord with an area of T2 hyperintensity at the level of compression [Figure 1] and [Figure 2]. Computed tomography (CT) angiography of the carotid–vertebral system showed medialization of the V3 segments of the bilateral vertebral arteries – the so-called “kissing vertebral artery” sign [Figure 3]. CT angiography also showed a hypodense flap through the lumen of the left vertebral artery – vertebral artery dissection [Figure 4]. The patient underwent operative management to decompress the spinal cord. The procedure done was C1–C2 laminectomy with transposition of the bilateral vertebral arteries and lateral mass screw fixation. On six months follow-up, there is improvement in the power of the bilateral upper limbs.[1],[2]
Figure 1: Axial T2-weighted MRI of the cervical spine shows medialization of V3 segments of bilateral vertebral arteries causing compression of the cervical cord

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Figure 2: Right parasagittal T2-weighted MRI of the cervical spinal cord shows intramedullary T2 hyperintensity at the level of compression

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Figure 3: Axial CT carotid angiography shows medialized V3 segments of bilateral vertebral arteries with a hypodense flap (arrowhead) through the lumen of the left vertebral artery – vertebral artery dissection

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Figure 4: Three-dimensional CT angiographic VRT (Volume Rendering Technique) image showing medialization of V3 segments of the bilateral vertebral arteries (arrow)

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  Procedure Top


The procedure done was MRI cervical spine and carotid CT angiography.


  Conclusion Top


This is a rare case of medialization of bilateral vertebral arteries causing cervical cord compression, coupled with left vertebral artery dissection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rahimi S, Shakir A, Alleyne C. Brainstem compression by “kissing vertebral arteries”. Neurology 2008;71:954.  Back to cited text no. 1
    
2.
Nutakki SR, Sharief AS, Pamidimukkala V. Kissing vertebral arteries – A technical note on vasculopexy of vertebral arteries. Int J Sci Stud 2020;8:7-10.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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