Vertebral artery web has been rarely identified compared to the frequently reported, carotid artery web as etiology of ischemic stroke. Here we present a young patient with symptomatic vertebral artery web.

35-year-old male presented with persistent, intermittent, bilateral visual scintillations lasting 30-60 seconds for one month. Neurological examination positive for bi nasal superior quadrantanopia. Computed tomography (CT) of head showed patchy hypo density in right posterior circulation artery (PCA) territory. Magnetic resonance imaging (MRI) showed restriction diffusion over bilateral PCA territories right greater than left.  MR Angiogram head and neck showed abnormal contour within right vertebral artery in V2 segment compatible with dissection. Patient’s hyper coagulable, inflammatory and rheumatological markers were unremarkable. The patient was started on aspirin 81 mg daily and Plavix 75 mg daily for three weeks followed by aspirin mono therapy. Repeat CT angiogram 11 months later still showed right V1/V2 junction irregularity. DSA performed one month later revealed right cervical vertebral artery web with mild stagnation of blood flow. Patient had no recurrence of symptoms and was continued on aspirin.