Basilar artery fenestration (BAF) is rare, and is usually insignificant clinically. However, it may lead to episodic dizziness. A 56-year-old female came to our hospital presenting episodes of dizziness, nausea, vomiting, photophobia, cold sweating, palpitation and severe rhinorrhea, which had lasted for over ten years. Hyperventilation test was positive. Pure tone audiometry showed mild bilateral sensori-neural hearing impairment. Although her electrocardiogram, neck duplex ultrasonography, and blood exams were normal, her electronystagmogram, caloric test and vestibular evoked myogenic potential were not. Magnetic resonance angiogram revealed a fenestration in the lower part of basilar artery, suggesting likely BAF. She was prescribed a brain circulatory promoters and anti-platelets. Two weeks later, her dizziness had subsided. She was continued on antiplatelet therapy and at six months her recovery was found to have remained uneventful.