Vertebral artery duplication is a rare neurovascular variant. In most cases, findings are incidental and not correlated with presenting symptoms. However, there are cases where variants are tied to underlying symptoms. We present a case where computed tomography (CT) angiography identified duplication of the left vertebral artery and provide a literature review on symptomatic and non-symptomatic cases. 

85-year-old woman presented with dysarthria and a fall for one day. Motor examination demonstrated full strength in all extremities except the right lower extremity which was pain limited. National Institute of Health Stroke Scale was 3. She underwent non contrast CT head and CT angiography vessel imaging. Findings revealed a left vertebral artery duplication originating from different locations along the aortic arch and fusing at the C4-5 vertebral level. The patient was administered an antiplatelet agent and a statin for secondary stroke prevention and was discharged upon improvement to baseline.    

A systematic review of SCOPUS and PubMed was conducted to find other cases of vertebral artery duplication. Examples were included if they met inclusion criteria for human and non-cadaveric cases.  

Through our literature review, 48 patients were found to have duplicate vertebral artery on imaging. Median age of patients was 50.5. Demographics of cases were largely equal with 22 male, 21 female, and 5 cases unknown. The laterality of vertebral duplication was 21 left, 22 right, 4 bilateral and one case unknown. CT, magnetic resonance imaging, and digital subtraction angiograms were modalities that were used to find vascular variants and abnormalities. Fusion of duplicated arteries occurred from C3 to C7 level.

Duplicated vertebral arteries are usually incidental findings on imaging and can be discovered using multiple imaging modalities, sometimes in conjunction with other vascular abnormalities. Close assessment of the vascular anatomy is necessary for neuro-interventional procedures.