Babinski-Nageotte syndrome after vertebral artery dissection and foramen arcuale

Vertebrobasilar ischaemia happens for a myriad of reasons. Among the rarest is the existence of a foramen arcuale (FA). This condition results from the ossification of the lateral edge of the posterior atlantooccipital membrane, closing, completely or partially, the top of this groove, turning it into a foramen or a channel. The estimated prevalence of this anatomical variant is around 9% for the complete form. It is postulated that entrapment of vertebral artery can occur. We share the case of a man in his 30s presenting with sudden imbalance, vertigo, vomiting and hiccups. Neurological observation disclosed Babinski-Nageotte syndrome. CT scan revealed left vertebral artery (VA) signs of dissection at its third segment (VA3), occlusion of its ipsilateral fourth segment (VA4) and bilateral FA. MRI confirmed ischaemic lesions in vertebrobasilar territory. The patient underwent surgical excision of contralateral FA. No new neurological adverse events occurred after 2 years of follow-up.