Vertebral artery dolichoectasia

Case contributed by Mahmoud Yacout Alabd
Diagnosis almost certain


Vertigo and dizziness since 1 month. MRI is done for assessment of possible central or peripheral causes of vertigo.

Patient Data

Age: 60 years
Gender: Female

MRI Brain


Dilated tortuous dominant V4 segment of the left vertebral artery compressing the medulla and cervico-medullary junction, still with no underlying signal abnormality of the medulla. No definite cranial nerve compression or vascular looping on thin slice T2 images. 

Incidentally noted also, widened partially empty sella.

Annotated image

Dolichoectasia of the V4 segment of the left vertebral artery. 

The left abducent nerve has the most intimate relation to the dilated artery, however no compression is seen on oblique MPR T2 image.

Bright signal seen within the left VA on filtered phase SWI, suggesting underlying atherosclerotic calcification.

Indentation and compression to the medulla and cervico-medullary junction by the dilated tortuous vessel.

Dilated V4 segment of the left VA reaching 5.5 mm.

Case Discussion

Although the vestibular nuclei are predominantly located at the medulla which is seen here compressed by the dilated left vertebral artery, the findings are likely not related to the patient's symptom of vertigo, since there is no underlying signal alteration of the compressed medulla and no definite cranial nerve compression. Dolichoectasia is also a long-standing process, while the patient's symptoms have started only 1 month prior to presentation. Furthermore, there is no associated neurological deficits or localizing symptoms which would be the case if the medullary compression was significant enough to affect the corticospinal tracts that are even located more anterior and closer to the abnormal artery than the vestibular nuclei. 

The V4 segment of the left VA is dominant (the right side could not be identified) with tortuous course and above normal caliber of 5.5 mm. Bright signal is also seen within the artery lumen on filtered phase SWI, which likely reflects underlying atherosclerotic calcifications, since this MRI sequence has the ability to differentiate between substances with paramagnetic and diamagnetic effects, hence differentiating between calcium and iron contents. 

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