Severe Bilateral Vertebral Arterial Disease Masquerading as Vertigo

Vertebral artery stenosis (VAS), manifesting as vertebrobasilar insufficiency (VBI), results from the narrowing of the vertebral artery's lumen because of diverse vascular pathological processes, leading to various clinical presentations. We present the case of a 71-year-old male who experienced vertigo for almost two years and was ultimately diagnosed with severe bilateral VAS. Despite initial management for vertigo, the patient's symptoms persisted, prompting a referral to a cardiologist. Several assessments were performed, including an MRI of the brain, which ruled out acute intracerebral hemorrhage or infarction. After some visits to the cardiologist's office, the patient was referred to a neurologist who conducted a magnetic resonance angiography (MRA) of the neck, which showed an occlusion of the left vertebral artery at the origin and a patent right vertebral artery. Because of worsening symptoms of vertigo and the results of the MRA, the patient underwent invasive angiography that confirmed the occlusion of the left vertebral artery and also revealed severe stenosis of the right vertebral artery. This case report discusses an unusual presentation of VAS with vertigo as the primary symptom, emphasizing the importance of recognizing seemingly minor symptoms as manifestations of the underlying vascular pathology that requires careful evaluation. Furthermore, this case emphasizes the limitation of relying solely on noninvasive imaging for diagnosis as, in this instance, noninvasive imaging failed to detect the severe stenosis of the right vertebral artery, which was revealed by invasive angiography. Finally, this case report underscores the significance of collaboration across several disciplines, such as cardiology, neurology, and radiology, as well as endovascular medicine in diagnosing and managing atypical manifestations of complex conditions.