Compression of the Vertebral Artery by the Thyroid Cartilage Causing Vertebrobasilar Insufficiency

Abstract

Background This retrospective case report describes a rare presentation of VBI in a young male patient. Aims Share a rare cause of VBI in a young patient. Materials & Methods The patient presented with recurrent episodes of dizziness and a history of several cerebellar infarcts. Imaging revealed the right vertebral artery was being mechanically compressed by the right superior cornu of the thyroid cartilage during mouth opening. Surgical resection of the right superior cornu of the thyroid cartilage was performed. Results Intraoperative angiography revealed a right vertebral artery without compression during mouth opening. Discussion Clinicians should consider the thyroid cartilage as a potential source of recurrent VBI due to mechanical compression of the VA. Conclusion Resection of the causative portion of the thyroid cartilage resolved the compression in this case, and should be employed in similar cases. Laryngoscope, 133:1214–1217, 2023

Review of Thyroid Cartilage Compression of the Vertebral Artery

“…At this point, the artery travels superiorly and is protected by the cervical spine. Aberrant variations in entry between C2-C6 have been reported at low rates (4-7%) [4,9] Entry at a level higher than C6 allows for extrinsic compression by structures within the neck [5]. This is confirmed by our review showing all cases had an aberrant extraforaminal course of the affected VA.…”

“…The vertebral arteries are paired vessels that ultimately perfuse the posterior cerebrum. Insufficient flow through the VAs can cause Vertebrobasilar Insufficiency (VBI) [3,4]. Symptoms of VBI include syncope, dizziness, vertigo, nausea, vomiting, ataxia, visual disturbance and headache [4][5][6].…”