A SERIES OF 3 PATIENTS WITH SYMPTOMATIC DOLICHOECTATIC
VERTEBROBASILAR ARTERIES
Abstract
Vertebrobasilar dolichoectasia is diagnosed by visual impressions as there are no generally accepted quantitative criteria for the diagnosis. Although the histological features are characteristic, the natural history of this condition, its prognosis and the appropriate management is still unclear. We present a series of 3 patients with massive symptomatic dolichoectatcic aterties and their management as well as a review of the current literature.

Cases
Case 1 is a 74 year old male with hypertension and ischemic heart disease presented with a sudden onset slurring of speech. This was accompanied by a left upper motor neuron 7th nerve, dysarthia and right sided hemiplegia (MRC grade 4). Computed tomography (CT) of his brain showcased a massive dolichoectatic vertebrobasilar artery with calcification(Figure 1) and an MRI of the brain provided further delineation of the abnormality and revealed the restricted deffusion in the left midbrain and pons consistent with an ischemic stroke (Figure 2).

Figure 1. ectatic calcified basilar artery Figure 2. DWI hyperintensity, pontine infarct
Case 2 is a 68 year old chinese male with hyperlipidemia, presented with left sided face numbness which progressively got worse. a CT was done for further evaluation. This showed a markedly ectatic calcified basilar artery (Figure 3). An MRI brain was done for further investigation, which showed an ectatic basilar artery indenting the right side of the anterior pons (Figure 4). The neurological deficits resulted from a mass effect on the underling trigeminal nucleus in the pons.

Figure 3. End-on calcified basilar artery Figure 4, indentation of pons Case 3 is a 72 year old Chinese female with giddiness and left hemiplegia and right facial droop. She was admitted