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Unilateral vertebral artery hypoplasia has been reported as possibly contributing to acute ischemia stroke or migraine with aura and could be related to episodic positional vertigo. An 88-year-old man presented with episodic vertigo whenever he rotated his head 90o to the right. He had experienced this for the last two years. Benign paroxysmal positional vertigo was initially suspected, but Epleyâ€™s canalith repositioning procedures failed to cure the symptom. The symptom was finally confirmed as related to right vertebral artery hypoplasia (VAH) after he had received a battery of studies, including an electronystagmogram, a color-coded duplex sonogram, and a magnetic resonance imaging/ angiogram. Thus, conservative treatment and life-style change were recommended and led to a decrease in recurrence. Herein we report this case and the oto-neurological significance of vertebral artery hypoplasia. In conclusion, one-sided head rotation related to episodic vertigo might be attributable to VAH.
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