SUMMARY The dolichoectatic basilar artery was found in 23 cases during a 10-year period. The 19 males and 4 females ranged in age from 30 to 69 years (mean: 55 years). Hypertension was noted in 17 patients. In seventeen (74%) of the present cases this anomaly could be visualized with CT scan. Seven patients (30%) presented with pontine infarction, which was identified on CT scan in all cases. Vertebro-basilar insufficiency was found in four patients. One patient had transient ischemic attacks. There were facial spasms in four patients and impairment of the lower cranial nerves in one. One patient exhibited cerebellar hemorrhage. In two patients this anomaly was found incidentally. Associated intracranial aneurysms were identified in seven patients, including fusiform aneurysms in 4 and saccular aneurysms in 3. Three patients had an accompanying hydrocephalus. The dolichoectatic basilar artery is associated with various consequences especially in relation to the pathogenesis of brainstem infarction. When this anomaly is diagnosed by CT findings, even if it is clinically asymptomatic, it may be better to treat these patients with medical therapy used to prevent ischemic stroke.

We report a patient who developed occasional vertigo when turning his head to the right side. Occlusion of the right vertebral artery occurred at the narrowed "scalenovertebral angle" with this rotational head movement. This triangular tunnel consisted of the hypertrophied ligament of the longus colli muscle and the anterior scalene muscle. Decompression of these extraluminal compressive factors led to relief of the symptoms. Two different kinds of extrinsic compression at the first portion of the vertebral artery are discussed.

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