Anomalous vertebral arteries and recurrent ischemic stroke: Insights from a unique case (first documented case-report from Syria).

RATIONALE: The posterior circulation represented by the vertebrobasilar artery system is responsible for 20% of brain perfusion. Posterior circulation ischemia can cause a variety of symptoms due to the broad area supplied by the vertebrobasilar artery. In addition, stroke is the second leading cause of death globally, highlighting the importance of studying any potential contributing factors.

PATIENT CONCERNS: A 68-year-old nonsmoker and nonalcoholic with a history of diabetes type 2 and a previous stroke, presented with 2 days of visual disturbance with a burning sensation associated with occipital headache, fever, and polyuria.

DIAGNOSIS: He was admitted to our hospital due to his symptoms and during his evaluation, a computed tomography scan was performed and showed a bilateral calcification on the vertebral arteries. Magnetic resonance angiography showed a variant vessel connected between the vertebral arteries at the level of medulla.

INTERVENTION: The patient was admitted to the intensive care unit after being diagnosed with stroke complicated with aspiration pneumonia and diabetic ketoacidosis. He was treated with IV fluids and insulin pump without using thrombolysis or vascular intervention due to the time of symptoms.

OUTCOMES: The patient's condition and laboratory tests improved and was discharged after 2 weeks.

LESSONS: This study investigates an extremely rare variant of the Circle of Willis and the potential consequences associated with such a variant, including stroke, which is considered one of the most lethal outcomes. The study highlights the importance of investigating the association between this variant and the incidence and frequency of stroke. The patient in the study developed stroke twice and atherosclerosis due to this variant.