Cervical radiculopathy may occur frequently due to disc disease. Also, neoplasms, cystic lesions, metabolic and vascular diseases, and congenital conditions should be considered when researching differential diagnoses [
1]. VALF is one of the rare conditions that can cause radiculopathy [
2]. This entity is often asymptomatic, but it can be symptomatic if it compresses a nerve root or the spinal cord. Widening of the cervical neural foramen is a very rare entity of VALF. Although this rare condition is described in the literature in the elderly [
2‐
4], it is even rarer in young patients such as ours. Although the etiology of VALF is not clear, hypotheses have been reported in the literature, including as a development secondary to cervical spondylotic degenerative changes, or due to atherosclerotic disease, or due to vertebral artery elongation caused by narrowing of disc space or trauma [
5‐
7]. However, because our patient was young, had no history of trauma, and lacked possible etiologic pathologies described in the literature, we assumed congenital causes may also contribute to the etiology of VALF. Ono
et al. reported that VALF is most commonly seen at the C4–C5 level, followed by C3–C4, and most frequently occurs on the left side [
1]. In cervical radiographs, erosion of the adjacent bone structure due to arterial pulsation as well as vertebral foramen and neural foramen expansion can be seen [
2]. Contrast-enhanced CT can provide a clear determination of VALF and its level, but MRA is more appropriate to prevent the patient from being exposed to ionizing radiation. For patients with cervical MR examinations, if there is an expansion of the vertebral foramen, VALF should be suspected and MRA should be performed [
3]. It has been reported in the literature that conservative methods rarely succeed in treatment of this condition [
8]. In addition, surgical approaches such as microvascular decompression and foraminotomy may be treatment options [
2]. However, it is important to consider serious risks that may affect the quality of life, especially in young patients, such as nerve root damage or vertebrobasilar system bleeding. Therefore, conservative management modalities are preferred in patients whose symptoms do not affect their daily lives. The treatment method should be determined on the basis of the patient’s age, symptoms, living conditions, and location of the vascular loop. A differential diagnosis of VALF and exclusion of other pathologies may be difficult with noncontrast examinations; however, with contrast-enhanced CT-MR or MRA, a VALF diagnosis can be easily confirmed [
3].