A 24-year-old male presented with recurrent posterior circulation strokes over 3 years despite aspirin and anticoagulation use. A comprehensive stroke workup was negative. Review of initial imaging revealed an exophytic left C1 lateral mass bony overgrowth posterior to the vertebral artery (VA) (Figure [B] and [C]). Angiography revealed a chronic traumatic dissection at the level of C1-2 foramen in an otherwise patient left VA. Angiography with right head turn showed complete occlusion of the left VA caused by extrinsic compression from the C1 lesion (Figure [D] through [F]; Video S1). He underwent surgical resection of a pathologically proven osteochondroma (Figure [F]). Postoperative dynamic imaging confirmed resolution of VA compromise and he remained asymptomatic over 3-months of follow-up. Osteochondroma-induced VA compromise is exceedingly rare.1 Dynamic extrinsic VA compression can be missed on noninvasive imaging.
- vertebral artery
ASJC Scopus subject areas
- Clinical Neurology
- Cardiology and Cardiovascular Medicine
- Advanced and Specialized Nursing