A 74-year-old man presented with a progressive gait disorder, mental impairment and urinary incontinence. MRI showed enlarged lateral ventricles and dolichoectasia of vertebrobasilar and carotid arteries, with prominent compression of the lower brainstem. An evacuative lumbar puncture improved the symptoms only marginally.
The most common clinical presentations of dilatative arteriopathy include acute brain ischemia and progressive compression of cranial nerves [1], and less frequently gait ataxia, pseudo-parkinsonism and cognitive impairment [2]. A possible explanation for the enlarged ventricles is the basilar artery lifting the floor of the third ventricle [1]. Figure. 1.
Dolichoectasia of the intracranial arteries. Note the dolichobasilar artery compressing and displacing the medulla oblongata (straight arrow) and lifting the floor of the third ventricle (dashed arrow)
References
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Smoker WR, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S (1986) High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review. AJNR Am J Neuroradiol 7(1):61–72
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Vandersteene, J., Santens, P. Severe dolichoectasia of the intracranial arteries. Acta Neurol Belg 112, 233 (2012). https://doi.org/10.1007/s13760-012-0045-x
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DOI: https://doi.org/10.1007/s13760-012-0045-x