Basilar artery dissection

Case contributed by Dr Mostafa El-Feky

Presentation

Frequent seizures for 2 months and slurred speech since 5 days. History of stroke since 2 years affecting speech and right sided weakness.

Patient Data

Age: 40 years
Gender: Male

Brain

MRI

Dolichoectasia of the basilar artery with increased diameter reaching 11 mm with intraluminal hyper & hypointense signal and a thin spiral intraluminal flap suggestive of basilar artery dissection. It is exerting mass effect upon the right side of the pons with encephalomalacic changes of the right side of the pons and midbrain.

High basilar tip location, indenting the floor of the third ventricle with no CSF flow obstruction or supratentorial ventricular dilatation.

Dominant right vertebral artery with tortuous course indenting the ventral aspect of the cervicomedullary junction, resulting in acute angulation of the junction posteriorly (seen on sagittal plane).

Case Discussion

MRI features of basilar artery dolichoectasia with dissection. The patient's symptoms are due to the compression of the right side of the brainstem by the enlarged tortuous basilar artery resulting in pontine ischemia, and the compression of the cervicomedullary junction by the posteriorly arched right vertebral artery. The enlarged basilar artery also extends upwards indenting the floor of the third ventricle, with a high tip/bifurcation. 

It is a rare type for intracranial arterial dissection. A more serious presentation for this condition is spontaneous subarachnoid hemorrhage 1.

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