Aim:The arcuate foramen (AF) variation localized on the vertebral artery (VA) sulcus posterior to the atlas has complete and incomplete types. Complete-type AF can exert pressure on the VA that passes through it, resulting in vertebrobasilar insufficiency finding, a Barré–Lièou syndrome (BLS) component. In patients with BLS, complaints could be decreased by the surgical decompression of VA at the AF level. However, a reliable theory regarding BLS has not yet been established; in addition, the reason why some of the cases do not respond to AF decompression has not been fully elucidated. We assumed that intracranial VA (V4) hypoplasia may be the main factor of the pathophysiology of BLS and aimed to investigate the possibility of their co-occurrence.Material and Methods:Cervical computed tomography and magnetic resonance angiography images of 139 patients aged 14–88 years with head and neck pain and dizziness were retrospectively evaluated. Results:Of the patients, 19.4% exhibited complete AF variation and 32.4% exhibited VA hypoplasia (VAH); 10% of the patients with VAH had accompanying contralateral complete AF variation. There was no significant relationship between complete AF variation and contralateral and ipsilateral VAHs (right side: p = 0.527 and p = 0.433, respectively; left side: p = 1.000 and p = 0.740, respectively). Conclusion:Our findings indicate that V4 hypoplasia cannot be the main factor of BLS pathophysiology. However, the rarity of the relationship may suggest why some cases do not respond to decompressive surgery.