An indolent headache revealing a megadolicho-diffuse vascular malformation

Abstract

A 61-year-old hypertensive man sought neurologic consultation due to a 20-year history of a right-sided dull headache of a low frequency, mild intensity, and without additional features. Headache responded to common analgesics and was not bothersome until his brother was diagnosed with cerebral aneurysm. He then pursued a brain vascular neuroimaging study. His brain magnetic resonance angiography revealed megadolicho-vascular malformation of the intracranial part of the internal carotid arteries and some of its branches and of the basilar artery ( Figure). Megadolicho-diffuse vascular malformation, involving both anterior and posterior circulations, is exceedingly rare and there are only a handful of published cases. Most cases are asymptomatic. When symptoms are present, they can be divided into ischemic, hemorrhagic, and mass effect. Reported manifestations include cerebellar dysfunction, ischemic stroke, trigeminal neuralgia, and brainstem compression syndrome.

Dolichoectasia of the right internal carotid artery diagnosed incidentally by MR angiography in a 17-year-old girl

“…Dolichoectasia is usually seen in the vertebrobasilar system, can affect the anterior circulation, especially the anterior cerebral artery and its branches [3], [8], and can affect both the vertebrobasilar system and anterior circulation simultaneously [2], [4], [5], [6], [7]. Most patients are aged and hypertensive.…”

“…Hudson and Gonsalves [1] reported a case of unilateral ventricular obstruction at the foramen of Monro by dolichoectasia of the contralateral ICA. Patients with multiple dolichoectasia tend to be symptomatic [5], [7].…”

“…Ectasia of the cerebral arteries with elongation is rare, most commonly observed in patients who are elderly and those with hypertension, frequently involves the basilar artery followed by the vertebral artery, a condition described as “dolichoectasia of the basilar artery” or “megadolicho basilar artery,” and can involve the anterior circulation, such as the internal carotid artery (ICA) and anterior cerebral artery [1], [2], [3], [4], [5], [6], [7], [8]. In this paper, we use the term “dolichoectasia.”…”

Long segment dolichoectasia of the right internal carotid artery diagnosed by CT angiography

“…Dolichoectasia is most frequently seen in the vertebrobasilar system, followed by the anterior circulation, especially the anterior cerebral artery and its branches [2], and the condition can affect the vertebrobasilar system and anterior circulation simultaneously [1], [3], [4], [5], [6]. Most patients are aged and hypertensive.…”

“…Generally described as either “dolichoectasia of the basilar artery” or “megadolicho basilar artery,” we use the term “dolichoectasia” in this paper. The condition can involve the anterior circulation, such as the intracranial segment of the internal carotid artery (ICA) and the anterior cerebral artery [1], [2], [3], [4], [5], [6], and is most commonly observed in patients who are elderly and those with hypertension.…”