Isolated intracranial arterial dolichoectasia of the anterior cerebral artery, a case report and review the literature

Abstract

Introduction: Intracranial arterial dolichoectasia (IADE) is a rare disorder that involves intracranial arteries, resulting in dilated, elongated, and tortuous vessels. The anterior circulation is rarely involved, and in most cases, the posterior circulation is usually affected. To better define the characteristics of ACA dolichoectasia, the study was conducted. Case presentation: The patient was a previously healthy young man who presented with headache. On physical examination, the Glasgow Coma Scale was 15/15 with no cranial nerve or focal neurologic deficits. There were no signs or symptoms of transient ischemic attack (TIA) or stroke. Brain MRI and MRA showed dilated, elongated, and tortuous vessels in the ACA territory in favor of a brain vascular lesion. He was referred to us with a probable and initial diagnosis of brain AVM or dAVF. Brain digital subtraction angiography (DSA) revealed symmetrical dilated, tortuous, and elongated bilateral ACA after the A1 segment without any obvious evidence of AVM or dAVF. There was stagnation and delayed blood flow washout in both A2 on angiography with normal venous drainage. The final diagnosis was isolated and symmetrical dolichoectatic ACA after the A1 segment. The patient underwent mono-antiplatelet therapy. Conclusion: Symmetrical and isolated involvement of the ACAs in a young man recalls the congenital source of the disease in the context of possibly a vascular problem in the ACAs. Further studies are needed to evaluate the congenital origin of the disease in the absence of underlying predisposing factors and to determine the reason for the isolated involvement of ACAs.

Keywords

• Intracranial arterial dolichoectasia
• Anterior cerebral artery
• Anterior circulation
• Dolichoectatic changes