Thalamic stroke in a patient with aberrant right vertebral artery arising from an atherosclerotic carotid bulb

Aberrant vertebral artery (VA) origins are uncommon, and those arising from the carotid bulb are exceedingly rare. We report a 79-year-old man with a right thalamic stroke and subsequent amaurosis fugax that was found to have severe right carotid bulb and internal carotid artery stenoses, as well as an aberrant VA arising from the bulb. He underwent carotid endarterectomy including eversion endarterectomy of the VA and had no recurrence of amaurosis fugax or posterior circulation symptoms at the 1-year follow-up. We also present a comprehensive review of the literature, focusing on symptomatic cases and those arising from the carotid bulb.