Abstract
Vertebral artery (VA) stenosis should be differentiated from VA hypoplasia. Atherosclerosis is the dominant pathology for VA stenosis. A 55-year-old man presented with hyperventilation vertigo twice in recent two years. When he visited our clinic, a hyperventilation test provoked severe vertigo. He was admitted for a series of study. The leftward caloric nystagmus was more prominent than the rightward one, and neither was suppressed by eye opening. A color-coded duplex sonogram showed that hyperventilation could reduce the cerebral blood flow. 3D time-of-flight magnetic resonance angiogram showed that the right VA was hypoplastic and the left intracranial VA was stenotic. The diffusion weighted image showed the bilateral flocculus became more intense by hyperventilation. After he was discharged, daily oral aspirin and life-style change were recommended. Over the following half year, it was uneventful. VA stenosis is usually noted in a victim of ischemic stroke, and is rarely noted in an ambulatory patient with simply hyperventilation vertigo.
Published Version
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