Vertebral Artery Dissection Presenting With Multilevel Combined Sensorimotor Radiculopathy

Abstract

This study is a case report demonstrating a rare clinical presentation of vertebral artery dissection. We believe that this is the first reported case with multilevel combined sensorimotor radiculopathy. We have also included a literature review. The purpose of this report is to inform the reader of a unique clinical presentation and to draw attention to some of the rare features of extracranial vertebral artery dissection. We believe that this condition is perhaps underrecognized and this paper may help to increase awareness, thereby encouraging prompt investigation, diagnosis, and implementing early treatment. The literature review also includes a brief anatomic and physiologic description of the underlying pathologic process. Only a small number of similar cases are described in the literature, though most describe a motor deficit at a single root level. Our case included both motor and sensory deficits at more than 1 level and we describe the possible physiologic and anatomic reasons for this. The case described is one that presented to our institution and was initially assessed by the first (corresponding) author. The literature review is based on articles identified from a PubMed search on vertebral artery dissection. The clinical and radiologic findings are discussed in the case report. Peripheral motor deficits are a rare clinical presentation of spontaneous vertebral artery dissection and tend to affect a solitary root level, typically C5. Sensation is usually preserved. We describe a case presenting with multilevel combined sensorimotor radiculopathy, which we believe has not previously been reported.