Varicella-zoster virus (VZV) has been known to cause intracranial vasculopathy. Herein, we report the case of a patient with VZV vasculopathy involving the vertebrobasilar system who underwent serial high-resolution vessel wall magnetic resonance imaging (HRVW-MRI). The disease continued to worsen radiographically despite clinical symptom improvement. We suggest that VZV vasculopathy may exhibit clinicoradiological dissociation that requires ongoing medical attention. HRVW-MRI may play a critical role in monitoring the disease activity.