J Neurocrit Care.  2019 Dec;12(2):117-121. 10.18700/jnc.190081.

Acute subarachnoid hemorrhage due to giant vertebrobasilar dolichoectasia

• Kim JY
• Kim JW
• Yoon MJ
• Suk SH

• KMID: 2470475
• DOI: http://doi.org/10.18700/jnc.190081

Abstract

BACKGROUND
Vertebrobasilar dolichoectasia (VBD) is a dilatative arteriopathy of the vertebrobasilar artery. Subarachnoid hemorrhage (SAH) is a rare but fatal complication of VBD.
CASE REPORT
A 65-year-old man was brought to the emergency room with altered mental status. Computed tomography angiography revealed the presence of SAH, and the rupture site was suspected to be the dolichoectatic portion of the vertebrobasilar artery. Twelve years previously, the patient had developed a right pontine infarct, and VBD had been detected. The basilar artery had dilated to a diameter of 22 mm and contained a mural thrombus. The patient's noncompliance to antihypertensive treatment led to VBD progression and a hemifacial spasm. He was admitted to the intensive care unit for conservative treatment. Consciousness was restored, but he developed quadriplegia.
CONCLUSION
In patients with a giant VBD, strict blood-pressure control is important to prevent fatal complications. Targeted surgical or endovascular procedures may improve patient outcomes but require further studies.

Keyword

Vertebrobasilar dolichoectasia; Hypertension; Subarachnoid hemorrhage

MeSH Terms

Aged
Angiography
Arteries
Basilar Artery
Consciousness
Emergency Service, Hospital
Endovascular Procedures
Hemifacial Spasm
Humans
Hypertension
Intensive Care Units
Quadriplegia
Rupture
Subarachnoid Hemorrhage*
Thrombosis
Vertebrobasilar Insufficiency*

Figure

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  Fig. 1. (A) Computed tomography of the brain revealed subarachnoid hemorrhage with intraventricular hemorrhage and hydrocephalus. (B) Subarachnoid hemorrhage involved the posterior fossa near the fusiform aneurysm of the basilar artery, the basilar cistern, and both the sylvian cisterns. (C, D) Computed tomography angiography of the brain showing a giant vertebrobasilar dolichoectasia involving the right vestibular and basilar arteries.

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  Fig. 2. (A, B) Magnetic resonance imaging (MRI) showing a giant vertebrobasilar dolichoectasia (22 mm in diameter) with a large mural thrombus within the tortuous basilar artery shifting the brainstem toward the right side. (C) Magnetic resonance angiography (MRA) demonstrating narrowing of the lumen of the basilar artery because of a thrombus. (D-F) MRI and MRA performed 5 months before the subarachnoid hemorrhage appeared showing no significant changes in the dimensions of the artery with vertebrobasilar dolichoectasia.

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