Case report: cervical intervertebral foramen widening caused by vertebral artery tortuosity--diagnosis with MR and colour-coded Doppler sonography.

Abstract

Widening of cervical intervertebral foramen owing to tortuosity of the vertebral artery is a rare condition, mimicking the presence of a tumour in the intervertebral foramen or an aneurysm of the vertebral artery (Schimmel et al, 1976). We present a patient with cervico-brachialgia, who had a right-sided loop of the vertebral artery in the intervertebral foramen at C4/5 level. Various authors have described the clinical and radiological manifestations of this anomaly by using vertebral angiography (Zimmerman & Farrell, 1970; Burnett & Staple, 1981; Royo Salvador et al, 1981). In this case, the diagnosis of this benign condition was made non-invasively with magnetic resonance tomography (MR) and confirmed by colour-coded duplex- Doppler sonography, and the patient thus escaped vertebral angiography. A 68-year-old male presented with cervicobrachialgia, which radiated into the right hand for several weeks. Physical examination showed numbness of the right palm, thumb and forefinger. Anteroposterior radiographs of the cervical spine, which had been obtained in an outpatient clinic, were unremarkable. A right anterior oblique radiograph showed a slight enlargement of the right C4/5 intervertebral foramen (Figure 1). A computed tomographic (CT) scan (Somatom 2N, Siemens) revealed a soft tissue mass and enlargement of the intervertebral foramen C4/5 on the same side, and a tumour in the intervertebral foramen was suggested (Figure 2). The patient was then referred to the department of neurosurgery of our hospital for further diagnostic work-up.