A case of vertebral artery compression syndrome mimicking primary lateral sclerosis

Abstract

Purpose

Vertebral artery compression syndrome (VACS) is an under-recognised condition that may be misdiagnosed as motor neuron disease. We report a case presenting features initially suggestive of primary lateral sclerosis (PLS) but later found to be VACS.

Case presentation

A 65-year-old man with hypertension was referred to our neurology department in the suspect of PLS. He presented with a 10-year history of involuntary jerk of the left lower limb, which ascended to the left upper limb 9 years later. He also developed intermittent painful spasms with a tendency to drag his left leg. His symptoms fluctuated with blood pressure. Neurological examination revealed upper motor neuron signs without lower motor neuron or sensory involvement. Electrophysiology studies were unremarkable. Brain MRI disclosed the left side of medulla oblongata was compressed by the tortuous left vertebral artery. Diffusion tensor tractography confirmed the corresponding corticospinal tract disruption. He was diagnosed with VACS and treated with antispasmodic medications and antihypertensive drugs.

Conclusions

VACS should be considered into the differential diagnoses of PLS. A thorough clinical assessment and careful interpretation of brain MRI with advanced diffusion neuroimages can help confirm the diagnosis.

Keywords:

• Vertebral artery
• compression
• primary lateral sclerosis
• diagnosis
• diffusion tensor tractography

Informed consent

Consent from the patient has been obtained.

Ethical statement

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the Natural Science Foundation of Guangdong Province, China [No. 2018A030313427].