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![]() Removal of bone and decompression of the vertebral artery were performed from the C5 to C6 levels. Dynamic cerebral angiography revealed vertebral artery dissection and compression at the C6 level due to a transverse process at the C6 level associated with rightward head rotation. Brain magnetic resonance imaging showed a high-intensity lesion in the right medial medulla. Kusunoki Nakamoto, Fumiko Hashimoto Maeda, Meiko Mori, Kentaro Hara, Takayuki Uesaka, YoshikazuĪ 52-year-old woman complained of the sudden onset of a left temporal headache, left neck stiffness and dizziness. Although we did not perform a genetic test for HSP, we consider that the spastic paraparesis and mild lower-limb hypesthesia were caused by compression of the medulla oblongata by bilateral tortuous vertebral arteries based on the post Bilateral pyramidal tract signs without cranial nerve dysfunction due to compression of the medulla oblongata by tortuous vertebral arteries are extremely rare and clinically indistinguishable from hereditary spastic paraplegia (HSP). The patient's symptoms and neurological findings improved gradually after the operation. Post-operative MRI revealed outward translocation of the right vertebral artery and relieved compression of the medulla oblongata on the right side. Neurovascular decompression of the right vertebral artery was performed because compression of the right side was more severe than that of the left side. Brain MRI and magnetic resonance angiography demonstrated bilateral tortuous vertebral arteries compressing the medulla oblongata. Cervical, thoracic and lumbo-sacral magnetic resonance imaging (MRI) findings were all normal. Nerve conduction and needle electromyographic studies of all four limbs revealed normal findings. Serum was negative for antibodies against human T-cell lymphotropic virus-1 antibody. Neurological examination on admission revealed lower-limb-dominant spasticity in all four extremities, lower-limb weakness, hyperreflexia in all extremities with positive Wartenberg's, Babinski's and Chaddock's signs, mild hypesthesia and hypopallesthesia in both lower limbs, and spastic gait. Blood pressure was normal and there were no signs of arteriosclerosis. ![]() He noticed weakness of both legs and gait disturbance at the age of 58 years and his symptoms progressively worsened during the following several months. ![]() We report a 58-year-old man showing spastic paraparesis due to medulla oblongata compression by tortuous vertebral arteries. Kamada, Takashi Tateishi, Takahisa Yamashita, Tamayo Nagata, Shinji Ohyagi, Yasumasa Kira, Jun-Ichi ![]()
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