Vertebral artery dissection (VAD) is one of important causes of posterior circulation strokes in young age patients. Typical presentations of VAD are occipital headache or posterior neck pain, with various signs arising from brainstem or cerebellar infarctions. Muscular weakness or sensory change of an ipsilateral arm owing to cervical nerve root involvement in association with the VAD has been reported very rarely. Herein we describe two unusual manifestations of extracranial VAD, which presented with monoplegia of single upper limb.