• Jibin Ren, Hongtao Sun, Yunfeng Diao, Xuegang Niu, Hang Wang, Zhengjun Wei, and Fei Yuan.
• Sixth Department of Neurosurgery, Affiliated Hospital of Armed Police Forces Logistical College, Tianjin, China; Postgraduate Training Base in Affiliated Hospital of Logistics University of People's Armed Police Forces, Jinzhou Medical University, Jinzhou, China.
• World Neurosurg. 2017 Dec 1; 108: 994.e11-994.e19.

BackgroundThere are few reports on hemiparesis caused by vascular medullary compression, which can occur because of dolichoectasia of the vertebrobasilar arterial system. In this article, we report a case of vertebral artery compression of the medulla oblongata in a 67-year-old woman.Case DescriptionThe patient was hypertensive, and she developed hemiparesis and intermittent spasms over 5 years. These spasms had worsened during the last year. Cranial nerve magnetic resonance imaging showed compression of the medulla oblongata by the left vertebral artery. A motor evoked potential (MEP) examination showed abnormal conduction of MEPs of bilateral toe abductors. The patient underwent microvascular decompression surgery under general anesthesia through a retrosigmoid keyhole approach. This operation led to relief of vascular compression and symptomatic improvement.ConclusionsOur case suggests that detailed history, imaging studies, and electrophysiologic studies help lead to a correct and early diagnosis of hemiparesis caused by vascular compression of the rostral ventrolateral medulla. Microvascular decompression surgery improves patient symptoms, and intraoperative electrophysiologic monitoring helps to avoid injury to important adjacent nerves.Copyright © 2017 Elsevier Inc. All rights reserved.

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