Presentation
Ground level fall. Complains of a headache and dizziness.
Patient Data
Non-enhanced CT shows an elongated and ectatic basilar artery with prominent co-dominant vertebral arteries. The basilar artery measures up to 9 mm in diameter at its proximal segment. Its tip and bifurcation point rise above the suprasellar cistern, abutting the floor of the 3rd ventricle. There is no secondary obstructive hydrocephalus.
There is a small left frontal scalp hematoma.
Case Discussion
Vertebrobasilar dolichoectasia refers to ectatic and elongated vertebral or basilar arteries, it is usually associated with deterioration of the tunica intima, which causes abnormal vessel distention, atheromatosis and low blood flow velocity that may favor ischemic disease.
There are several etiologic mechanism theories that have been proposed, such as hypertension, atherosclerosis, congenital factors such as autosomal recessive polycystic kidney disease, Fabry disease, Marfan and Ehlers-Danlos syndromes, as well as sickle cell anemia, among others.
It is asymptomatic in many cases, but in symptomatic patients, the clinical manifestations can include a wide variety of neurological deficits, including stroke, brainstem compression syndromes, cranial neuropathies and obstructive hydrocephalus.
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