Vertebral artery thrombosis is a potentially life-threatening vascular event that can occur after injury to the cervical spine, vertebral artery dissection, but also surgical intervention. When the vertebral artery is occluded, symptoms arise depending on which part of the brain is affected by ischemia. Dizziness, diplopia, Wallenberg syndrome, and even locked-in syndrome are some of the possible manifestations. Vertebral artery thrombosis must be recognized early on and imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI), and CT angiography are the cornerstone for establishing the diagnosis.
The clinical presentation of vertebral artery thrombosis significantly depends on the location of occlusion   . Wallenberg syndrome is a term denoting ischemia of the lateral medulla arising from the obstruction of the intracranial vertebral artery, manifesting as Horner's syndrome (ptosis, anhydrosis, and miosis), ataxia, dysphagia, and a reduced sensation of temperature and pain on the ipsilateral side of the face and contralateral side of the body . If the middle segment of the vertebrobasilar artery (VBA) territory is affected, the most likely cause is occlusion of the basilar artery, which may, in turn, promote ischemia of the pons, quadriplegia, and anarthria with preserved consciousness, more widely known as "locked-in syndrome"  . Coma is, in fact, a possible manifestation in the setting of iatrogenic vertebral artery thrombosis and occlusion (for example, after surgery of the cervical spine or catheterization of the internal jugular vein) . However, the most common symptoms and signs of vertebral artery thrombosis are nausea, vomiting, pain in the head and neck areas, and dizziness  . Weakness, dysarthria, and impaired mental state are also frequent findings in the setting of a vascular insult involving the vertebral arteries  .
Because of the life-threatening nature of the disorder, vertebral artery thrombosis must be recognized as soon as possible. The first and most important components of the workup are a properly obtained patient history (during which the exact onset of symptoms, the circumstances that preceded their appearance, and their progression must be revealed) and a thorough physical examination that confirms neurological deficits caused by ischemia. Clinical findings should be strong enough to raise a suspicion toward an ongoing process related to the vertebral arteries, which is particularly supported if prior trauma or surgical/diagnostic procedure involving the cervical area have happened. Still, the diagnosis is confirmed through the employment of various imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI), MR or CT angiography (MRA and CTA, respectively)     . Digital subtraction angiography (DSA), although being the most reliable study, is very risky due to its invasiveness. Moreover, there is the potential need for general anesthesia . If thromboembolus is suspected to have originated from the heart, cardiac ultrasonography should be performed .