Positional vertebrobasilar insufficiency induced by head rotation due to cervical disc herniation: A case report

Of the many causes of vertebrobasilar insufficiency (VBI), extrinsic compression of the vertebral artery (VA) is relatively rare. We report a case of VBI caused by VA compression due to a herniated cervical disc in a 54-year-old male patient who presented with syncope, manifesting when he turned his head to the left. Magnetic resonance imaging confirmed disc herniation at C5-6 on his left side. CT scan showed no osteophyte formation or bony compression elements were noted in the left C5-6 vertebrae. Cervical angiography showed that the left VA was occluded when he turned his head to the left. The contralateral right VA on one side was hypoplastic and posterior inferior cerebellar artery (PICA)-end. He was successfully treated with an anterior cervical discectomy and fusion. Cervical disc herniation can be a cause of VBI. Preoperative and intraoperative dynamic angiography can be useful in confirming this condition.