Ectasia of the basilar artery: The breadth of the clinical spectrum and the diagnostic value of computed tomography

108

Background and Purpose-Vertebrobasilar dolichoectasia (VBD) may produce symptoms by direct compression of cranial nerves or the brain stem, by obstructive hydrocephalus, or by ischemia in the vertebrobasilar arterial territory. This study was undertaken to examine and characterize clinical and imaging findings in patients with stroke associated with VBD and compare these data with those for patients with VBD who did not have a stroke. Methods-We studied 40 consecutive stroke patients with associated VBD. All were evaluated by CT scan (nϭ9), MRI (nϭ6), or both (nϭ25). The diameter of the basilar artery (BA), height of bifurcation, and transverse position were evaluated. Clinical and imaging findings were compared with those found in a group of 40 VBD patients without stroke. Results-More than half of the patients (24 of 40) had infratentorial infarcts, located mainly in the midpons. Sixteen patients had supratentorial lesions localized in the thalamus (nϭ8) or in the superficial arterial territory of the posterior cerebral artery (PCA; nϭ8). The diameter and height of the bifurcation of the BA were correlated with the location of the lesion (PCA territory versus BA territory), in that severe ectasia and vertical elongation of the BA were significantly more often observed in patients with infarcts in PCA territory than in patients with infarcts in territories supplied by branches of the BA. Comparison of VBD patients with and without stroke showed that the incidence of arterial hypertension and the degree of ectasia and lateral displacement of the BA were not significantly different in the two groups. Patients with stroke more often had atherosclerotic changes of the posterior circulation (Pϭ.0006) and a higher degree of vertical elongation of the BA (Pϭ.025). Conclusions-In patients with VBD, superimposed atheromatous changes of the posterior circulation may have an important role in precipitating ischemia. However, other factors related to the severity of the dolichoectasia also favor ischemia and in some cases are the only factors responsible. (Stroke. 1998;29:653-659.)

Section: Discussionmentioning

confidence: 51%

Posterior Circulation Infarcts in Patients With Vertebrobasilar Dolichoectasia

Passero¹,

Filosomi²

1998

108

“…6 artery must be confirmed by angiography, but the anomaly has been identified by CT scan. 7 ' 9~" In seventeen (74%) of our cases this abnormality was visualized with CT scan.…”

Section: Discussionmentioning

confidence: 67%

Dolichoectatic basilar artery: a review of 23 cases.

Nishizaki¹,

Tamaki²,

Takeda³

et al. 1986

118

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.

“…C linical expression of vertebrobasilar dolichoectasia (VBD) is variable and includes compression of cranial nerves or brain stem, [1][2][3][4][5] obstructive hydrocephalus, 3,6 and ischemia in vertebrobasilar arterial territory. [7][8][9][10][11][12][13] However, pathological changes in the arterial wall, consisting primarily in defects in the internal elastic lamina with thinning of the media secondary to smooth muscle atrophy, 14 -16 may predispose patients to intracranial bleeding of various kinds.…”

mentioning

confidence: 99%

Intracranial Bleeding in Patients With Vertebrobasilar Dolichoectasia

Passero

Calchetti

Bartalini

2005

Background and Purpose-Intracranial bleeding in patients with vertebrobasilar dolichoectasia (VBD) is considered uncommon, but there are no precise data to support this opinion. The purpose of this study was to examine the incidence and characteristics of intracranial hemorrhage in patients with VBD and to evaluate factors that may promote bleeding. Methods-We conducted a prospective study of 156 consecutive VDB patients followed-up for an average 9.35 years. The association of demographic, clinical, and imaging features with occurrence of intracranial bleeding was evaluated by multivariate analysis. Survival analysis was used to evaluate rates of incidence. Results-32 hemorrhagic strokes were observed in 28 patients either as a diagnostic event (nϭ10) or during follow-up (nϭ22