A case of intracranial arterial dolichoectasia with 4 repeated cerebral infarctions in 6 months and enlargement of basilar artery

Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities: A case report

RATIONALE

The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment.

PATIENT CONCERNS

A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nausea, and vomiting was admitted to the emergency department. Fifteen years prior to this admission, he began taking levamlodipine besylate inconsistently for hypertension, but the level of blood pressure control was uncertain. The patient's father had a family history of hypertension.

DIAGNOSES

An emergency axial computed tomography scan of the brain showed basilar artery (BA) dilation. Computed tomography angiography further indicated a maximum BA diameter of 38.94 mm. The length was >182 mm. MRI revealed acute infarctions of the right medulla oblongata and pons. Meanwhile, the patient had evidence of cerebral small vessel disease, including cerebral microbleeds and white matter hyperintensities. Whole-exome sequencing eliminated significant genetic variations consistent with clinical phenotypes. BD and intramural hematoma were further confirmed by high-resolution MRI of the arterial wall.

INTERVENTIONS

Atorvastatin was admitted according to the results of the high-resolution MRI of the arterial wall. Benidipine hydrochloride was selected as a long-term anti-hypertensive drug.

OUTCOMES

The patient had no symptoms of neurological damage during 3-month follow-up.

LESSONS

Current evidence shows that BD has no obvious correlation with atherosclerosis. BA dissection and uncontrolled hypertension may be important factors in the progression of BD. BD-related stroke is likely to recur, and there are no standard secondary prevention measures. BD is often accompanied by cerebral microbleeds, and bleeding risk must be assessed during secondary prevention. When the BA diameter is greater than 10 mm, anti-platelet medication should be used with caution, blood pressure should be strictly controlled, and endovascular treatment should be considered.

Extensive intracranial arterial dolichoectasia involving distal branches of intracranial arteries: two cases report and review of the literature

With the rapid development of noninvasive angiography techniques such as Magnetic Resonance Angiography (MRA) and Computer Tomography Angiography (CTA), more and more patients with intracranial arterial dolichoectasia (IADE) have been found, and clinical studies on this kind of vascular abnormity have become hot subjects in neurology. We presented two young patients with IADE extensively involving the branches of intracranial arteries, which were different from patients described in other articles. A young male patient was diagnosed with IADE after examination on admission, and further detailed examination revealed that the patient had osteropathia striata. Another young woman had an arterial malformation that mainly affected the distal branch of the intracranial artery. These two cases give us another perspective to look into IADE.