The use of dynamic magnetic resonance angiography in the diagnosis of rotational vertebral artery syndrome

Background Rotational vertebral artery (VA) syndrome represents a rare mechanical vasculopathy that can lead to vertebrobasilar insufficiency and ischemic stroke. Objective We describe a 10‐year‐old boy with a history of chronic morning emesis who presented with acute onset dizziness, gait instability, and vomiting and was diagnosed with acute ischemic posterior circulation stroke. Interpretation Contrast‐enhanced magnetic resonance angiography (MRA) of the head and neck with dynamic positioning demonstrated loss of flow‐related enhancement with head tilted to the left, conferring a diagnosis of rotational VA syndrome. He started aspirin monotherapy and subsequently underwent C1 laminectomy, with both radiographic and clinical improvement on follow‐up. Conclusion Dynamic contrasted‐enhanced MRA imaging can serve as a noninvasive alternative to digital subtraction angiography in the diagnosis of rotational VA syndrome and should be considered in suspected cases of pediatric rotational arteriopathy.