Abstract
The authors report two cases of rotational vertebrobasilar insufficiency (VBI). Both patients presented with vertigo and syncope attacks at the time of head rotation. They were diagnosed with rotational VBI by dynamic angiography performed with their upper body elevated and head rotated. In both patients, the vertebral arteries were being compressed by osteophytes of the cervical spine resulting in stenosis and occlusion of the artery thereby manifesting the associated symptoms. The patients underwent anterior fusion of the cervical vertebra as well as removal of the offending osteophytes, and their symptoms disappeared. Rotational VBI should be suspected in patients with vertigo and syncope whose vertebral artery is hypoplastic or occuluded on one side. Anterior fusion of the cervical vertebra to limit rotation of the cervical spine and occlusion of the VA is an effective treatment for rotational VBI.
