A case of a patient with vertebrobasilar dolichoectasia complicated by hydrocephalus, impaired consciousness, and brain stem infarction due to rapid elongation of the basilar artery

Abstract

Here, we report a case of a patient with vertebrobasilar dolichoectasia (VBD) complicated by hydrocephalus after almost 4 years of observation. In the 61-year-old male patient, the basilar artery directly elevated the floor of the third-ventricle obstructing the foramen of Monro and causing hydrocephalus. The patient had a decreased consciousness level; therefore, we performed bilateral ventriculoperitoneal shunting. Although hydrocephalus was improved by the shunt surgery, and the patient temporarily recovered, he did not have a good outcome because of sustained impaired consciousness and brain stem infarction. To summarize, in the 4 years of observation, the patient was clinically stable for 3 years, followed by sudden-onset and rapid elongation of the basilar artery, causing hydrocephalus and impaired consciousness due to the decreased blood flow velocity in the basilar artery. Further, elongation caused distortion of the perforating artery of the brain stem, resulting in brain stem infarction. From our point of view, these events such as hydrocephalus, impaired consciousness, and brain stem infarction are serial changes caused by the rapid elongation of the basilar artery. While following patients with VBD, measuring the length of the basilar artery is useful as any drastic changes in it are crucial for predicting the events that complicate VBD.