The use of dynamic magnetic resonance angiography in the diagnosis of rotational vertebral artery syndrome

Background

Rotational vertebral artery (VA) syndrome represents a rare mechanical vasculopathy that can lead to vertebrobasilar insufficiency and ischemic stroke.

Objective

We describe a 10-year-old boy with a history of chronic morning emesis who presented with acute onset dizziness, gait instability, and vomiting and was diagnosed with acute ischemic posterior circulation stroke.

Interpretation

Contrast-enhanced magnetic resonance angiography (MRA) of the head and neck with dynamic positioning demonstrated loss of flow-related enhancement with head tilted to the left, conferring a diagnosis of rotational VA syndrome. He started aspirin monotherapy and subsequently underwent C1 laminectomy, with both radiographic and clinical improvement on follow-up.

Conclusion

Dynamic contrasted-enhanced MRA imaging can serve as a noninvasive alternative to digital subtraction angiography in the diagnosis of rotational VA syndrome and should be considered in suspected cases of pediatric rotational arteriopathy.