Basilar artery dolichoectasia can lead to ischemic stroke through thrombosis of small perforating vessels of the brainstem. Here we report the case of a patient with transient paramedian pontine syndrome in the setting of a hypertensive crisis, finding a dolichoectasia basilar artery compressing on the ventral surface of the pons. The outcome was near-complete resolution of deficits after blood pressure control. We propose increased basilar artery pulse pressure as a novel mechanism of transient compression of the brainstem by a dolichoectasia artery.
GutierrezJBagciAGardenerH, et al. Dolichoectasia diagnostic methods in a multi-ethnic, stroke-free cohort: results from the northern Manhattan study. J Neuroimaging2014; 24: 226–31.
2.
PasseroSGRossiS.Natural history of vertebrobasilar dolichoectasia. Neurology2008; 70: 66–72.
3.
LvXYuJZhangW, et al. Acute hemorrhagic cerebral artery dissection: Characteristics and endovascular treatment. Neuroradiol J2020; 33: 112–117.
4.
LiQXiePYangWS, et al. Vertebral artery compression syndrome. Front neurol2019; 10: 1075.
5.
YangXSLiSTZhongJ, et al. Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes. Acta neurochir2012; 154: 793–7; discussion 7.
6.
SiddiquiAChewNSMiszkielK.Vertebrobasilar dolichoectasia: a rare cause of obstructive hydrocephalus: case report. Brit J Radiol2008; 81: e123-6.
7.
KumralEKisabayAAtacC, et al. The mechanism of ischemic stroke in patients with dolichoectatic basilar artery. Eur J Neurol2005; 12: 437–44.
8.
PasseroSFilosomiG.Posterior circulation infarcts in patients with vertebrobasilar dolichoectasia. Stroke. 1998; 29: 653–9.
9.
PicoFLabreucheJAmarencoP.Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia. Lancet Neurol2015; 14: 833–45.
10.
PicoFLabreucheJSeilheanD, et al. Association of small-vessel disease with dilatative arteriopathy of the brain: neuropathologic evidence. Stroke. 2007; 38: 1197–202.
11.
MokhberNShariatzahAAvanA, et al. Cerebral blood flow changes during aging process and in cognitive disorders: A review. Neuroradiol J2021; 19714009211002778 ahead of print.
