Abstract
Background: Anatomical anomalies of the vertebral arteries—such as looping or kinking—are frequently incidental findings on vascular imaging and often dismissed as clinically benign. Nonetheless, evidence is accumulating that such dolichoarteriopathies can alter hemodynamics or precipitate thrombogenic conditions, thereby contributing to posterior-circulation cerebrovascular events.
Case presentation: We report a 52-year-old male with no prior cardiovascular risk factors who developed a sudden, severe occipital (“thunderclap”) headache during sexual intercourse, followed by dysarthria, dysphagia, truncal ataxia and hemisensory deficits. Imaging revealed an acute right dorsolateral medullary infarct consistent with Wallenberg syndrome and bilateral kinking of the vertebral arteries with contrast stagnation. Given the presumed causative vascular anomaly, the patient underwent bilateral rigid stenting via the endovascular route, tolerated the intervention uneventfully and achieved significant neurological improvement on discharge.
Conclusions: This case underscores that vertebral?artery kinking should not be dismissed as a benign anatomical variant. In selected patients presenting with posterior-circulation stroke without conventional atherothrombotic risk factors, recognition of this vascular anomaly may permit targeted endovascular intervention and reduce stroke recurrence. The case further highlights the need for heightened clinical vigilance, advanced imaging to assess flow dynamics, and individualised management strategies beyond conservative therapy.
