The vertebral arteries supply the cerebellum, brainstem, and posterior cerebral hemispheres (posterior circulation) after joining to form the basilar artery at the pontomedullary junction. Their passage through the cervical foramina transversaria makes them vulnerable to cervical spine fractures, chiropractic manipulation, and extreme neck rotation. Vertebral artery dissection produces the lateral medullary (Wallenberg) syndrome from PICA territory infarction when it occurs distally.
| Origin | First branch of the subclavian artery |
|---|---|
| Course | Ascends through the foramina transversaria of C6 to C1, loops behind the atlantoaxial joint, pierces the posterior atlantooccipital membrane, enters the cranium through the foramen magnum, and joins the contralateral vertebral artery to form the basilar artery |
| Branches |
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Vertebral artery dissection from sudden neck hyperextension or rotation (including chiropractic manipulation, yoga, and hairdressing) produces occipital headache, neck pain, and posterior circulation stroke symptoms including vertigo, ataxia, diplopia, and Horner syndrome. The posterior inferior cerebellar artery (PICA) is most commonly involved in vertebral artery territory strokes, producing the Wallenberg syndrome of ipsilateral face and contralateral body pain and temperature loss with ataxia, dysphagia, and Horner syndrome.
Intimal tear from neck manipulation or trauma producing occlusion and PICA territory infarction causing Wallenberg lateral medullary syndrome, managed with anticoagulation and supportive rehabilitation.
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