Short case... Arterial ectasia of the vertebrobasilar system

1. Short case publication... version 1.5 | Edited by professor Yasser Metwally | January 2008
Short case
Edited by
Professor Yasser Metwally
Professor of neurology
Ain Shams university school of medicine
Cairo, Egypt
Visit my web site at:
http://yassermetwally.com
A 60 years old male patient presented clinically with a clinical picture simulating the cerebellopontine angle
syndrome with 7th, 5th, bulbar cranial nerve manifestations, cerebellar deficits and tinnitus in the right ear.
Symptoms are gradual and progressive. The patient is hypertensive, with evidence of concentric left ventricular
hypertrophy and type IV hyperlipidemia. The patient was not diabetic.
DIAGNOSIS: FUSIFORM ANEURYSM OF THE VERTEBROBASILAR SYSTEM WITH MURAL
THROMBOSIS

2. Figure 1. Postcontrast CT scan showing fusiform aneurysm affecting the vertebral arteries, the arteries are
asymmetrically dilated, oval in shape, laterally placed and encroaching upon the cerebellopontine angle, with
significant indentation of the brain stem. Also notice the mural calcification.
Figure 2. Postcontrast CT scan showing fusiform aneurysm affecting the vertebral arteries, the arteries are
asymmetrically dilated, oval in shape, laterally placed and encroaching upon the cerebellopontine angle, with
significant indentation of the brain stem. Also notice the mural calcification.

3. Figure 3. Precontrast CT scans showing basilar artery fusiform aneurysm, notice the rounded configuration, the
midline location in the prepontine cistern, and the precontrast hyperdensity that could be due to thrombosis (
density below that of calcification).
Figure 4. Conventional angiography showing basilar artery fusiform aneurysm. Mural thrombosis is probably
present.

4. SUMMARY
Intracranial fusiform aneurysms
Commonly involve the vertebrobasilar system and might extend to involve other arteries around the circle of
Willis
Involved arteries are diffusely dilated, tortuous, kinked, abnormally prolonged with frequent mural thrombosis
and occasional wall calcification.
Fusiform aneurysms rarely rupture or produce subarachnoid haemorrhage
Fusiform aneurysms are commonly associated with microvascular brain disease
The clinical presentation of fusiform aneurysms includes
Ischemic manifestations
Pressure due to the mass effect of greatly dilated fusiform aneurysms
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References
1. Metwally, MYM: Textbook of neurimaging, A CD-ROM publication, (Metwally, MYM editor) WEB-CD agency
for electronic publishing, version 9.1a January 2008