Oligosymptomatic and giant basilar artery dolichoectasia discovered after a stroke: case report

Abstract

The most frequently diagnosed complication of vertebrobasilar dolichoectasia (VBD) is the compression of structures adjacent to the vertebral and basilar arteries. A giant VBD with only slight compressive symptoms is unusual. In this setting, the diagnosis of VBD may be casually revealed after the occurrence of a posterior circulation stroke, another potential complication. We report a 48-year-old woman who presented a two-month history of continuous buzz and a slight right-sided hearing loss that was followed by a cerebellar ischemic stroke. Brain CT and MRI revealed a marked compression of the brainstem due to an ectatic, tortuous and partially thrombosed basilar artery (BA). The largest cross-sectional diameter of BA was 18 mm. The patient had a good functional recovery within the two-month follow-up after stroke with modified Rankin scale score (mRSS)=2. At the one-year follow-up, patient still kept the complaints of continuous buzz, slight right-sided hearing loss and the mRSS was the same. We call attention for an unusual giant VBD that caused an impressive brainstem compression with displacement of important structures in an oligosymptomatic patient. Diagnosis was made only after the occurrence of a stroke. Despite of the good functional recovery after stroke, the presence of significant atherosclerotic changes and the large BA diameter may indicate a poor outcome. However, after one year, she remains oligosymptomatic.

The �8 of Willis�: large anterior communicating artery fenestration associated with posterior circulation anomalies

“…The authors proposed that direct compression of the XI th and VII th cranial nerves by the dolichoectatic left vertebral artery might be the mechanism responsible for myoclonus in their patient 21 . Campos et al 9 reported a 48-yearold woman who presented a twomonth history of continuous buzz and a slight right-sided hearing loss that was followed by a cerebellar ischemic stroke. Brain CT and MRI revealed a marked compression of the brainstem due to an ectatic, tortuous and partially thrombosed basilar artery.…”

“…Diagnosis was made only after the occurrence of a stroke. According to the authors, the presence of significant atherosclerotic changes and the large basilar artery diameter may indicate a poor outcome 9 . Interestingly, Tsutsumi et al 22 reported a 71-year-old female with basilar and bilateral carotid dolichoectasia manifesting as dysarthria and hemisensory disturbance, which resolved spontaneously within a day.…”

“…A giant VBD with only slight compressive symptoms is unusual 9 . Further, VBD can trigger various clinical symptoms such as posterior circulation stroke (including ischemia of cervical spine, cerebellum and cerebral trunk, as well as occipital lobe syndromes), cranial nerve palsies, subarachnoid or intracerebral haemorrhages and even symptoms of a neoplasm in the posterior fossa and in the cerebellopontine angle, but there is no effective treatment for their prevention [9][10][11][12] . The clinical symptom that should be stressed is headache, which precedes the occurrence of stroke for several days 12 .…”