Catastrophic subarachnoid hemorrhage resulting from ruptured vertebrobasilar dolichoectasia: case report.
OBJECTIVE
Two patients with vertebrobasilar dolichoectasia sustained massive fatal subarachnoid hemorrhage from rupture of the basilar artery wall. Hemorrhage from this entity is not widely known to occur during its natural history and may be exacerbated by systemic anticoagulation.


METHODS
Two patients presented with ischemic events of the brain stem, which were attributed to vertebrobasilar dolichoectasia. The diagnosis was made on the basis of computed tomography and subsequent angiography.


METHODS
Both patients were treated with systemic anticoagulation with heparin and subsequently experienced massive fatal subarachnoid hemorrhage. Autopsy results confirmed the cause of hemorrhage to be frank rupture of the basilar artery wall.


CONCLUSIONS
Vertebrobasilar dolichoectasia is a formidable structural entity afflicting the posterior circulation, which is generally thought to cause symptoms as a result of either compression of the adjacent brain stem and/or cranial nerves or ischemic events caused by thrombosis and perforator occlusion. Our experience with these two patients indicates that some lesions can hemorrhage, which is a factor that must be weighed when considering treatment alternatives.
Rabb
C H
CH
Division of Neurosurgery, Oregon Health Sciences University, Portland 97201-3098, USA.
Barnwell
S L
SL
D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000925:Anticoagulants / Q000009:adverse effects; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000473:pathology; D002388:Catastrophic Illness / Q000628:therapy; D017809:Fatal Outcome; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology
D000925:Anticoagulants; D006493:Heparin