Ataxia and vertigo due to anomalous origin of the left
vertebral artery
Roberto Gabrielli, MD, PhD,a and Maria Sofia Rosati, MD, PhD,b Rome, Italy

The origin of anomalies of the left vertebral artery has been previously described. The
vertebral artery is a collateral branch of subclavian artery and takes a posterior-vertical
course to usually enter into the sixth cervical transverse foramen (88%).1
We report a case of a 64-year-old woman who presented with syncope and a 30-year
history of vertigo during left head rotation. Physical examination showed bilateral vertical
nystagmus and ataxia during deambulation with left head rotation. The duplex ultrasound
showed the hemodynamically significant right carotid stenosis. The computed tomography
angiography confirmed the carotid stenosis (A) with right vertebral artery hypoplasia (B)
and left vertebral artery originated directly from the aortic arch between left carotid and
subclavian arteries (A). There was additional abnormality of absence of the inferior thyroid
branch of the thyrocervical trunk in the left side. The left vertebral artery in our case enters
the forth transverse foramen (C; Video, online only).
The patient underwent right carotid artery endarterectomy under plexus anesthesia.
No complications were observed in the postoperative period. Her recovery was uneventful
and she was discharged on postoperative day 3 with antiplatelet therapy. Six-month
follow-up Doppler demonstrated carotid and vertebral arteries patency. The patient still
complains of vertigo during left head rotation.
DISCUSSION
The brachiocephalic trunk, left common carotid artery, and left subclavian artery are
the typical three branches that arise from the aortic arch. However, the left vertebral artery
arises from the arch of the aorta in approximately 6% of the population; in a few cases, it
arises from the left common carotid artery or the root of the left subclavian artery.2
The patients with left vertebral artery anomalies are usually asymptomatic. Rare cases
have presented with dizziness, but this does not seem to be associated with the anomalous
origin. In our cases, the left vertebral artery origin anomaly with its C4 entrance and
contralateral hypoplasia could be causing the ataxia during head rotation.
Accurate assessment of anatomic variations of vertebral arteries is mandatory before
supra-aortic artery surgery and for planning aortic arch surgery or endovascular interventions.
REFERENCES
1. Kubikova E, Osvaldova M, Mizerakova P, El Falougy H, Benuska J. A variable origin of the vertebral artery. Bratisl
Lek Listy 2008;109:28-30.
2. Koenigsberg RA, Pereira L, Nair B, McCormick D, Schwartzman R. Unusual vertebral artery origins: examples
and related pathology. Catheter Cardiovasc Interv 2003;59:244-50.
Submitted Apr 9, 2012; accepted Apr 24, 2012.
From the Department of Vascular and Endovascular Surgery, Policlinico Casilinoa; and Sapienza, University of Rome.b
Author conflict of interest: none.
E-mail: rogadoc@libero.it.
Additional material for this article may be found online at www.jvascsurg.org.
The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that
requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
J Vasc Surg 2013;58:803
0741-5214/$36.00
Copyright © 2013 by the Society for Vascular Surgery.
http://dx.doi.org/10.1016/j.jvs.2012.04.045

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