# Left Anterolateral Medullary Compression Due to Vertebral Artery Dolichoectasia: A Case Report and Review of Literature

## TL;DR

A 73-year-old woman with high blood pressure had unexplained falls and fainting spells due to a rare condition where a blood vessel in her neck compressed part of her brainstem.

## Contribution

This case report highlights the role of advanced imaging in diagnosing vertebral artery dolichoectasia and emphasizes the need for multidisciplinary treatment.

## Key findings

- MRI revealed left vertebral artery dolichoectasia compressing the left anterolateral medulla.
- The patient's symptoms were linked to disruption of autonomic and motor pathways due to this compression.
- Multidisciplinary management was recommended to address the condition.

## Abstract

Vertebral artery dolichoectasia, characterized by the elongation, dilation, and tortuosity of the vertebral arteries, poses significant clinical challenges due to its potential to compress adjacent neural structures, particularly the medulla oblongata. This case report presents a 73-year-old hypertensive female with recurrent episodes of falls and transient loss of consciousness. Initial assessments including echocardiography and a four-vessel Doppler study were unremarkable, prompting further evaluation with MRI. High-resolution imaging sequences revealed significant dolichoectasia of the left vertebral artery, compressing the left anterolateral medulla. This compression disrupted vital autonomic and motor pathways, explaining the patient's symptoms. Management involved a multidisciplinary approach, incorporating conservative measures, potential endovascular intervention, and neurosurgical consultation. This case underscores the importance of advanced imaging techniques in diagnosing vertebral artery dolichoectasia and highlights the need for a comprehensive, multidisciplinary treatment strategy to optimize patient outcomes.