Journal of Neurology

, Volume 267, Issue 1, pp 276–278 | Cite as

Compression of both vertebral arteries during neck extension: a new type of vertebral artery compression syndrome

  • So-Yeon Yun
  • Ju Young Lee
  • Eun-Jin Kwon
  • Cheolkyu Jung
  • Xu Yang
  • Ji-Soo KimEmail author
Letter to the Editors

Dear Editor,

The vertebral artery (VA) may be compressed during lateral head rotation or tilt, causing vertigo, tinnitus, nystagmus and syncope due to compromise of the blood flow in the vertebrobasilar artery territory [1, 2, 3]. In this rotational VA occlusion (RVAO), patients typically have a stenosis or hypoplasia of VA on one side and the dominant VA is compressed at the C1-2 level during contraversive head rotation [3, 4, 5]. We describe a new type of mechanical VA compression syndrome in which paroxysmal vertigo and downbeat nystagmus occur due to compression of both VAs during head extension mostly while sitting.

A 73-year-old woman presented recurrent vertigo for one year. The vertigo occurred only when she extended her neck, and resolved immediately on resuming the neutral head position. She reported nausea, but no tinnitus or hearing loss during the attacks. She had a history of hypertension for five years and dyslipidemia for 10 years.

Findings of physical and neurological...


Author contribution

Dr. Yun analyzed and interpreted the data, and wrote the manuscript. Drs. Lee, Kwon, Jung, and Yang analyzed and interpreted the data, and revised the manuscript. Dr. Kim designed and conceptualized the study, interpreted the data, and revised the manuscript.


This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (no. NRF-2016R1D1A1B04935568).

Compliance with ethical standards

Conflicts of interest

Drs. Yun, Lee, Kwon, Jung and Yang report no disclosures. Dr. Kim serves as an associate editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, Journal of Neurology, and Medicine.

Ethical standard

This study followed the tenets of the Declaration of Helsinki, and was performed according to the guidelines of Institutional Review Board of Seoul National University Bundang Hospital (B-1906-544-702).

Supplementary material

Video. The patient shows paroxysmal nystagmus beating to the right and downward along with nausea and vertigo during extension of the neck while sitting. The patient was asked to raise her arm when she developed vertigo. (WMV 26935 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Dizziness Center, Clinical Neuroscience Center, and Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
  2. 2.Department of RadiologySeoul National University Bundang HospitalSeongnamSouth Korea
  3. 3.Department of Neurology, Aerospace Center HospitalPeking University Aerospace School of Clinical MedicinePekingChina
  4. 4.Department of NeurologySeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnam-siSouth Korea

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