A 69-year-old female patient presented with headache for 30 days. She had no other clinical manifestation or significant past medical history. There was no abnormal finding at the initial neurological examination.\nShe underwent cranial magnetic resonance image (MRI) with 3D time-of-flight (TOF) intracranial MRA and gadolinium-enhanced neck MRA, using 1.5T system (Signa Excite, GE Medical Systems, Milwaukee, WI, USA). Routine cranial MR images revealed no significant focal lesion in the brain parenchyma. 3D TOF intracranial MRA was also normal. Contrast-enhanced neck MRA demonstrated a duplication of the right VA with two origins from ipsilateral SCA before the origin of right internal thoracic artery (Fig. ). The two limbs of duplicated VA confined to proximal V1 segment, and converged to form one main trunk at the 3.6 cm distal from each orifice. The first and second limbs of duplicated V1 segment measured 2.8 and 2.6 mm in diameter at the points of origin, respectively. The distance between two limbs calculated 8.0 mm. The diameter of the common trunk of right VA was 3.8 mm at the point of reconstitution. On the left side, the VA arose from the left SCA and measured 4.1 mm in diameter. There was no other vascular abnormality in the major cervical arteries. The patient was managed conservatively and the patient’s clinical symptoms were relieved after 7 days.
A 36 year-old male with a history of dizziness and suspected cerebrovascular pathology was referred to our center for angiographic evaluation of carotid and vertebral arteries. He underwent multidetector 64-row computed tomography (MDCT) angiography. (GE: Optima660,2011, Tokyo, Japan60). Eighty-five milliliter of nonionic iohexolcontrast (Omnipaque, 350 mg I/ml, GE Healthcare, Shanghai, China) was injected at a rate of 5 ml/s by a power injector through the antecubital vein. The acquired images (slice thickness 0.625 mm) were further analyzed in a work station (GE: AW Volume Share 4) to generate volume-rendered (VR) and maximum intensity projection (MIP) images.\nThe left vertebral artery (LVA) had two separate limbs of origin []. The medial limb (2.2 mm in diameter at its origin) originated directly from the aortic arch in between the origins of left common carotid (LCCA) and left subclavian arteries (LSA) []. The lateral limb (2.4 mm in diameter at its origin) emanated from the LSA in its orthodox position and entered the foramen transversarium of C6 vertebra. Both the limbs united to form a single trunk at C5-C6 interval and the single trunk (3.2 mm in diameter) then entered C5 transverse foramen [Figures and ]. Both the limbs of the right vertebral artery (RVA) originated from the right subclavian artery (RSA) []. The medial limb (3.9 mm in diameter at its origin) originated from its orthodox position, whereas the lateral limb (2.4 mm in diameter at its origin) arose more posteriorly close to the origin of thyrocervical trunk. The lateral limb entered the C6 transverse foramen, but the medial limb entered the carotid space lying posteromedial to right common carotid artery (CCA) []. At the interval between the C4 and C5 vertebrae, both the limbs fused to form a single trunk (4.4 mm in diameter) which entered the C4 transverse foramen [Figures and ]. Further distal course of both vertebral arteries was normal and no cerebrovascular pathology could be detected.