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Dolichoectasia

The term dolichoectasia means dilated and elongated. It is used to characterise arteries which have shown significant deterioration of their tunica intima (and occasionally the tunica media), weakening the vessel walls and causing the artery to elongate and distend.

Epidemiology

Dolichoectasias are most common in males 2. With intracranial dolichoectasia the incidence is estimated at between 0.06 and 5.8 % 2

Clinical presentation

Ischaemic effects on the brain stem and cerebellar hemispheres as well as symptoms related to hydrocephalus are common. Direct cranial nerve compression can lead to isolated cranial nerve dysfunction, usually associated with a normal-sized basilar artery that is tortuous and elongated (neurovascular compression syndrome(NVCS)). Cranial nerve dysfunction most commonly involves the VII cranial nerve and the V cranial nerve. Multiple cranial nerve dysfunction is far more likely to occur if there is dilation (ectasia) associated with a tortuous and elongated basilar artery. Cranial nerves affected in descending order of frequency include: VIIVIIIVIII, and VI.

Pathology

As the arrangement of connective tissue is disturbed, the vessel wall is no longer able to hold its original conformation and begins to unravel due to the continued hypertension. High blood pressure mold and force the artery to now take on an elongated, tortuous course to better withstand the higher pressures.

Sub types

Can be divided into several sub types 3

  • atherosclerotic dolichoectasia
  • non atheroscerotic dolichoectasia
  • dolichoectatic appearance secondary to an arterial dissection
Aetiology

The atherosclerotic type is most commonly caused by hypertension, continued stress on the walls of the artery will degrade the vessel wall by damaging and loosening the collagen and elastin meshwork which comprises the intima. Similarly, hypercholesterolemia or hyperlipidemia can also provide sufficient trauma to the vessel wall resulting in dolichoectasia.

Location
Associations

Radiographic features

It order to be classified as dolichoectasia in verbrobasilar system, the basilar arterial diameter should be more than 4.5mm 1

Internal carotid artery dolichoectasia is particularly interesting because the artery normally already contains one hairpin turn. Seen in an MRI as two individual arteries at this hairpin, a carotid artery dolichoectasia can progress so far as to produce a second hairpin turn and appear as three individual arteries on an MRI. The pathogenesis is primarily related to compression of the optic nerves at the optic chiasma. 

Complications

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