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OBJECTIVE: Temporal arteritis (TA) affects large arteries, including the vertebral arteries in up to 15% of cases. High resolution ultrasonography (US) is widely used for noninvasive imaging of the extracranial vertebral arteries. We assessed the prevalence of vertebrobasilar ischemia and structural abnormalities of the extracranial vertebral arteries by US in patients with TA and polymyalgia rheumatica (PMR) and in healthy controls. METHODS: This prospective study included clinical and US data from 93 patients with TA and 34 with PMR. A comparison was made with US findings in a population based, age matched group of 203 elderly subjects. RESULTS: Vertebrobasilar ischemia in 4 patients with TA was less frequent (4.3%) than neuroophthalmological complications (27.9%). In all 4 patients vertebrobasilar ischemia was associated with proximal vertebral artery occlusive disease. The rate of stenosis (> 50%) and occlusions of the vertebral arteries was significantly higher in the TA patients (12.9%) than in the PMR patients (2.9%) and controls (3%). Concentric hypoechogenic mural thickening of the proximal segments V0/V1 of the vertebral artery was found in only one PMR patient and 2 TA patients. CONCLUSION: Vertebrobasilar ischemia is an uncommon complication of TA. Color duplex sonography can help to detect temporal arteritis of the vertebral arteries. Hypoechogenic mural thickening in TA can be indistinguishable from wall hematoma caused by vertebral artery dissection and atherothrombotic occlusive disease.