Locked-in syndrome and abnormal orientation of the right vertebral artery in a young man.

A 35-year-old man developed a cerebral infarction and experienced transient ischemic attacks originating from the vertebrobasilar artery, as well as locked-in syndrome. He recovered with minimal neurological deficit. On cerebral angiography, the orientation of the right vertebral artery was markedly abnormal as it entered the foramina of the transverse process at the level of the third cervical vertebra. We concluded that the abnormal orientation of the vertebral artery caused the thrombosis and that the transient ischemic attacks, locked-in syndrome and cerebral infarction were brought about by thromboemboli originating in this artery.