Hemorrhagic infarction originating from vertebral artery stenosis caused by an osteophyte at the C5 superior articular process.

A 62-year-old man presented with right upper homonymous quadrihemianopsia. Magnetic resonance imaging showed hemorrhagic infarctions in the bilateral occipital lobes and infarction in the left cerebellar hemisphere. Digital subtraction angiography and three-dimensional computed tomography angiography revealed right vertebral artery (VA) stenosis caused by an osteophyte at the C5 superior articular process. The VA stenosis was aggravated by neck extension. The brain infarctions were attributed to embolism from the right VA stenosis. Unroofing of the anterior root of the right C4 transverse foramen, removal of the osteophyte at the superior articular process of C5, and anterior fusion at C4-5 were performed. His postoperative course was uneventful.