Dolichoectasia of the vertebral basilar and internal carotid arteries: A case report and literature review
A 67-year-old male with a known dolichoectasia of his vertebrobasilar artery, presented with a history of increasing falls over the past 3 months. A computed tomography (CT) scan of the head [] and magnetic resonance imaging (MRI) of the brain [] demonstrated a VBD with formation of a focal fusiform aneurysm in the proximal basilar artery. This caused mass effect on the left anterior aspect of the adjacent pons.\nA magnetic resonance (MR) angiogram [] revealed fusiform dilatation of the intradural distal right vertebral artery giving rise to the dysplastic dilated basilar artery, which had increased in size. The lumen was within a larger partially thrombosed vessel. This gave rise to a short segment of normal caliber basilar artery, which then again dilated just proximal to the basilar tip. There was also a new fusiform dilatation of the posterior cavernous left internal carotid artery consistent with a fusiform aneurysm. There was presence of ventriculomegaly of the lateral and 3rd ventricle, with the 4th ventricle being collapsed.\nHis past medical history included: Hypertension, dyslipidemia, long time smoker, chronic obstructive pulmonary disease, previous transient ischemic attack, depression, and prostate cancer treated with radiotherapy and NSTEMI treated with PCI (two bare metal stents).\nThe presence of new ventriculomegaly on imaging raised the possibility of symptomatic hydrocephalus. A radionuclide cerebrospinal fluid (CSF) flow study was undertaken. It revealed normal migration of the radio tracer from the subarachnoid lumbar space to the basal cisterns and sylvian fissures, with no activity within the lateral ventricles in the 24 and 48 hour images. However, the patient also underwent a trial of lumbar drainage, during which his gait was assessed by the medical allied health team documenting an objective improvement in his gait. Consequently, the patient had a ventriculoperitoneal (VP) shunt inserted with no complications.