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Cervical radiculopathy secondary to a tortuous vertebral artery. Case illustration.

This 66-year-old woman presented with a 2-year history of rightsided neck pain, radiating shoulder pain, and right-sided headaches. Physical findings were significant for poorly controlled hypertension. The results of a neurological examination were completely normal. Initial cervical radiographs revealed an enlarged neural foramen on the right side at C4-5 with osteolysis of the C-4 pedicle (Fig. 1). Magnetic resonance (MR) imaging confirmed the enlarged neural foramen and revealed what appeared to be a cystic cavity filled with cerebrospinal fluid (Fig. 2). An MR angiogram showed tortuosity of the right vertebral artery with evidence of a prominent medially projecting loop at the C4-5 level (Fig. 3). An electromyogram demonstrated active denervation in the right C4-5 paraspinal region, as evidenced by axonal injury in the form offibrillations and positive sharp waves. This case has been followed for 4 years, with