Khanzada TW, Makhdoomi KR.
Vertebral Artery Pseudoaneurysm.
J Pak Med Assoc Jan ;52(4):185-7.

A 60 years old housewife sustained head and neck trauma in a road traffic accident, following which she developed neurological symptoms including numbness, weakness and pain in both upper limbs. These symptoms became severe over a period of two months especially on the left side. On examination the muscle power of the left arm was 3/5 and she was unable to move the arm because of pain. MRI of the neck was performed and a diagnosis of cervical disc prolapse was made. She underwent cervical discectomy in April 2000, which was uneventful except for excessive peri-operative bleeding which stopped after applying pressure. Following the operation her neurological symptoms improved but a month and half later she developed difficulty in swallowing and felt pulsation in the throat. The swallowing got worse and reduced to liquids only. She also noticed a swelling in the left side of the neck, which was labeled as an abscess on ultrasound scan. Patient was taken to the theater for incision and drainage of the abscess. On making the skin incision the swelling was noticeably pulsatile, the skin was closed and arteriogram was performed which revealed a pseudoaneurysm of the vertebral artery arising from its intra-spinal part at the level of C3 - 4. The patient was referred to the vascular team for further management. After discussing different options including interventional radiology with the patient, a decision for open repair was taken. The operation was performed by anterior approach. Vertebral artery was dissected out at its origin before it enters the osseous canal (V2 segment) and was ligated. Next V3 segment of the vertebral artery was dissected out and ligated. Patient woke up without any neurological deficit and remains well after twelve months. Postoperatively the symptoms have improved and now she is able to swallow solids.

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