A 48 year old man with no vascular risk factors sustained a minor hyperextension injury of the neck whilst playing basketball.  He had migraine with visual aura since age 13. There followed 5 months of frequent visual aura and paraesthesia in both arms often accompanied by neck pain.  X-ray of the cervical spine showed bilateral cervical ribs. 
 He woke with a left visual loss and whilst opening his bowels developed a sudden mild left hemiparesis.  On examination he had a left upper quadrantanopia and mild left hemiparesis. Initial CT brain and angiography were normal and aspirin was given. Over the next 10 days, in spite of antiplatelet and latterly oral anticoagulation with Dabigatran, he developed numerous posterior circulation infarcts culminating in massive fatal brain stem infarction.  Transthoracic echocardiography showed no valve or cardiac chamber abnormality and telemetry no atrial fibrillation.  Vasculitis screen was negative.  Retrograde thrombus extension from subclavian artery damage due to cervical rib has been described.  Images will be shown.

Can cervical ribs lead to progressive posterior circulation infarction and death?