Abstract
A 59-year-old man presented with sudden onset of vertigo, headache, nausea, and left-hand clumsiness. Neurological examination showed multidirectional nystagmus and left kinetic cerebellar syndrome. The patient did not have neck injury. Brain MRI showed acute infarction in the region of the left posterior inferior cerebellar artery (fi gure A). CT angiography showed left vertebral artery stenosis caused by extrinsic compression by an osteophyte of the superior articular process of the fourth cervical vertebra, compromising the foramen transversarium, with a downstream occlusion of the left vertebral artery in its extracranial segment (fi gure B, C). Extrinsic compression of the vertebral artery is a rare complication of cervical osteophytes. Embolic infarction rarely occurs. Surgical treatment can be proposed to decompress the artery.
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