Acute subarachnoid hemorrhage due to giant vertebrobasilar dolichoectasia

Abstract

Background Vertebrobasilar dolichoectasia (VBD) is a dilatative arteriopathy of the vertebrobasilar artery. Subarachnoid hemorrhage (SAH) is a rare but fatal complication of VBD. Case Report A 65-year-old man was brought to the emergency room with altered mental status. Computed tomography angiography revealed the presence of SAH, and the rupture site was suspected to be the dolichoectatic portion of the vertebrobasilar artery. Twelve years previously, the patient had developed a right pontine infarct, and VBD had been detected. The basilar artery had dilated to a diameter of 22 mm and contained a mural thrombus. The patient’s noncompliance to antihypertensive treatment led to VBD progression and a hemifacial spasm. He was admitted to the intensive care unit for conservative treatment. Consciousness was restored, but he developed quadriplegia. Conclusion In patients with a giant VBD, strict blood-pressure control is important to prevent fatal complications. Targeted surgical or endovascular procedures may improve patient outcomes but require further studies.

Keywords

• vertebrobasilar dolichoectasia
• hypertension
• subarachnoid hemorrhage