Rapid Progression of Symptomatic Vertebrobasilar Artery Dissection on Magnetic Resonance Imaging: A Case Report

Kim, Hyung-Seok; Kwak, Hyo-Sung; Hwang, Seung Bae; Chung, Gyung Ho

doi:10.5469/neuroint.2014.9.2.106

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…Therefore, for patients with BD, attention should be paid to changes in the arterial wall other than the characteristics of atherosclerotic plaque [13] . Arterial dissection and intramural hematoma may cause a BA hemodynamic disturbance [14,15] . Uncontrolled high blood pressure may be a factor in the acceleration of BD [16] …”

Section: Discussionmentioning

confidence: 99%

Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities

Wang

Zhang

et al. 2021

Medicine

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Rationale:The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment.Patient concerns:A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nausea, and vomiting was admitted to the emergency department. Fifteen years prior to this admission, he began taking levamlodipine besylate inconsistently for hypertension, but the level of blood pressure control was uncertain. The patient's father had a family history of hypertension.Diagnoses:An emergency axial computed tomography scan of the brain showed basilar artery (BA) dilation. Computed tomography angiography further indicated a maximum BA diameter of 38.94 mm. The length was >182 mm. MRI revealed acute infarctions of the right medulla oblongata and pons. Meanwhile, the patient had evidence of cerebral small vessel disease, including cerebral microbleeds and white matter hyperintensities. Whole-exome sequencing eliminated significant genetic variations consistent with clinical phenotypes. BD and intramural hematoma were further confirmed by high-resolution MRI of the arterial wall.Interventions:Atorvastatin was admitted according to the results of the high-resolution MRI of the arterial wall. Benidipine hydrochloride was selected as a long-term anti-hypertensive drug.Outcomes:The patient had no symptoms of neurological damage during 3-month follow-up.Lessons:Current evidence shows that BD has no obvious correlation with atherosclerosis. BA dissection and uncontrolled hypertension may be important factors in the progression of BD. BD-related stroke is likely to recur, and there are no standard secondary prevention measures. BD is often accompanied by cerebral microbleeds, and bleeding risk must be assessed during secondary prevention. When the BA diameter is greater than 10 mm, anti-platelet medication should be used with caution, blood pressure should be strictly controlled, and endovascular treatment should be considered.

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Section: Discussionmentioning

confidence: 99%

Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities

Wang

Zhang

et al. 2021

Medicine

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“…Importantly, the development of intramural hematoma is also a vital step in the pathological progression of dolichoectasia (17). Thus, vertebrobasilar artery dissection may also contribute to the exacerbation of VBD (13, 18). When the initial artery diameter is larger than 10 mm, alternative treatments like endovascular procedures and antihypertensive therapy should be considered (19).…”

Section: Discussionmentioning

confidence: 99%

Vertebrobasilar Dolichoectasia and Basilar Artery Dissection Presenting With Trigeminal Neuralgia: A Case Report

2019

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Trigeminal neuralgia secondary to vertebrobasilar dolichoectasia and basilar artery dissection is rare. The authors report the case of a 72-year-old man with a 5-year history of right electrical facial pain identical with trigeminal neuralgia. Finally, magnetic resonance imaging and digital subtraction angiography revealed basilar artery dissection and vertebrobasilar dolichoectasia. The patient underwent partial basilar dissecting aneurysm embolization. The facial pain was relieved immediately after the operation and disappeared completely 6 months later. Three years after surgery, the patient had experienced no recurrence of the right facial pain.

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“…Furthermore, based on findings indicating that VBD is related to arterial dissection and the presence of a vessel wall hematoma, the authors of a previous study suggested that the two pathologies may share etiologies [ 14 ]. Additionally, abnormal hemodynamic stress may play an important role in arterial dissection and vessel wall hematoma formation [ 15 , 16 ]. Thus, vertebrobasilar artery dissection may accelerate the progression of VBD [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, abnormal hemodynamic stress may play an important role in arterial dissection and vessel wall hematoma formation [ 15 , 16 ]. Thus, vertebrobasilar artery dissection may accelerate the progression of VBD [ 15 ]. Importantly, vessel wall hematoma development is also a crucial step in the pathological progression of dolichoectasia [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Why does my patient’s basilar artery continue to grow? A four-year case study of a patient with symptoms of vertebrobasilar dolichoectasia

et al. 2018

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BackgroundVertebrobasilar dolichoectasia (VBD) is a clinical entity associated with ischemic stroke, compression of cranial nerves or brainstem, and hydrocephalus. There have been relatively few studies following the progression of VBD in patients presenting with a variety of diverse clinical features.Case presentationHere, we report a case study of a male with progressive VBD who was followed from November 2012 to December 2016. The patient had diagnosed hypertension for several years and suffered from left peripheral facial paralysis, recurrent ischemic attacks in the brainstem and cerebellum, obstructive hydrocephalus and frequent pneumonia. A series of cranial CT and multi-modal MRI scans were performed to explore the brain imaging features of the patient during follow-up.ConclusionsThe presented case study suggests that aging, uncontrolled hypertension, arterial dissection and infection may contribute to the exacerbation of VBD and recurrent ischemic stroke.

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Rapid Progression of Symptomatic Vertebrobasilar Artery Dissection on Magnetic Resonance Imaging: A Case Report

Cited by 4 publications

References 9 publications

Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities

Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities

Vertebrobasilar Dolichoectasia and Basilar Artery Dissection Presenting With Trigeminal Neuralgia: A Case Report

Why does my patient’s basilar artery continue to grow? A four-year case study of a patient with symptoms of vertebrobasilar dolichoectasia

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