Presentation
Female patient complaining of right ear otalgia and right-side facial discomfort (spasm).
Patient Data
Both vertebral arteries and the basilar artery appear elongated, distended, and tortuous, measuring about 6.5 mm, 5.6 mm, and 6.3 mm for the right, left vertebral arteries, and basilar artery, respectively. The left vertebral artery deviates to the right side, joining the right one at the medial aspect of the medulla oblongata. The right vertebral artery takes a turn, abutting the right internal acoustic canal (IAC), cerebellum, and the brain stem, causing mild mass effects.
In the precontrast scan, both the right and left vertebral arteries show circumferential calcified plaques; however, they remain patent and opacified on post-contrast.
There is a well-defined enhancing lesion of about 16 x 15 mm in the left frontal lobe, overlaying the left lesser wing of the sphenoid bone. The lesion exhibits a few calcified foci in the precontrast study, indicative of a left sphenoid meningioma.
The above findings suggest dolichoectasia, and compression of adjacent cranial nerves, mainly on the right side, including the facial nerve, should be considered for clinical correlation and further workup (a high-resolution MRI is advisable).
Case Discussion
Dolichoectasia can be considered when the vertebral artery is dilated, tortuous, and elongated, with a diameter more than 4.5 mm. This condition can affect nearby structures, including the cranial nerves. In this case, the patient presented with facial spasm, mostly related to the compression of the facial nerve.
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