An indolent headache revealing a megadolicho-diffuse vascular malformation

Cefaleia indolente revelando uma malformação vascular megadolicoectásica difusa

A 61-year-old hypertensive man sought neurologic consultation due to a 20-year history of a right-sided dull headache of a low frequency, mild intensity, and without additional features. Headache responded to common analgesics and was not bothersome until his brother was diagnosed with cerebral aneurysm. He then pursued a brain vascular neuroimaging study. His brain magnetic resonance angiography revealed megadolicho-vascular malformation of the intracranial part of the internal carotid arteries and some of its branches and of the basilar artery (Figure). Megadolicho-diffuse vascular malformation, involving both anterior and posterior circulations, is exceedingly rare and there are only a handful of published cases. Most cases are asymptomatic. When symptoms are present, they can be divided into ischemic, hemorrhagic, and mass effect. Reported manifestations include cerebellar dysfunction, ischemic stroke, trigeminal neuralgia, and brainstem compression syndrome. Multiple pathophysiological processes might contribute to the development of such arterial ectasia vessels such as systemic arterial hypertension associated with atherosclerosis, what might have occurred in our patient^1,2,3,4.

Figure
A post-contrast 3D SPGR brain magnetic resonance imaging showing megadolichoectasias of the basilar and the bilateral internal carotid arteries (A). A post-processed 3D-TOF sequence of brain MR angiography, with an inverted window and MIP algorithm, showing a diffuse megadolichoectasia of the bilateral internal carotid arteries (B). A post-processed 3D-TOF sequence of brain MR angiography, with an inverted window and MIP algorithm, showing diffuse megadolichoectasia of the basilar artery (C). A post-processed 3D-TOF sequence of brain MR angiography, using a surface-shaded display, showing megadolichoectasias of the basilar and bilateral internal carotid arteries (D).

References

• ¹
  Yuh S, Alkherayf F, Lesiuk H. Dolichoectasia of the vertebral basilar and internal carotid arteries: case report and literature review. Surg Neurol Int 2013;4:153.
• ²
  Herpers M, Lodder J, Janevski B, van der Lugt PJ. The symptomatology of megadolicho basilar artery. Clin Neurol Neurosurg 1983;85:203-212.
• ³
  Lodder J, Janevski B, van der Lugt PJ. Megadolicho vascular malformation of the intracranial arteries. Clin Neurol Neurosurg 1981;83:11-18.
• ⁴
  Borota L, Jonasson P. Basilar and bilateral carotid dolichoectasia with spontaneous dissection of C2 segment of the internal carotid artery. AJNR Am J Neuroradiol 2006;27:1241-1244.

Publication Dates

• Publication in this collection
  Sept 2014

History

• Received
  27 Mar 2014
• Reviewed
  14 May 2014
• Accepted
  17 June 2014