The dilemma of treating vertebrobasilar dolichoectasia.
Vertebrobasilar dolichoectasia (VBD) is a common phenomenon among people over 50 years old, and the related clinical expressions are varied. One of our VBD patients presented with brainstem infarction initially, received low molecular weight heparin treatment, and developed rupture of the dolichoectasia segment. Another patient with a similar-sized VBD experienced recurrent brainstem infarction three times over 2 years, despite higher bleeding tendency and long-term antiplatelet treatment. The third patient with a smallersized VBD, had left hemiplegia and received intravenous recombinant tissue plasminogen activator within 3 h, totally recovered with no lesions detected on brain Magnetic Resonance Imaging (MRI). The pathophysiology of VBD is unique, its prevalence and risks of ischemic stroke and intracranial hemorrhage both increase as the degree of arterial dolichoectasia extends, making the strategy of management quite a challenge. The best management of VBD is controlling arterial hypertension and following up with image studies regularly to detect the early extension of VBD degree.
Department of Neurology, Mackay Memorial Hospital, Taipei;
Yu-Wei
YW
Lin
Stroke Center and Department of Neurology, National Cheng Kung University Hospital, Tainan; ; College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Chih-Hung
CH
Chen
Stroke Center and Department of Neurology, National Cheng Kung University Hospital, Tainan; ; College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Ming-Liang
ML
Lai
basilar artery occlusion; ischemic stroke; non-saccular intracranial aneurysm; subarachnoid hemorrhage.; vertebrobasilar dolichoectasia