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A dolichoectatic aneurysm is a giant fusiform aneurysm characterized by elongation, tortuosity, and ectasia. It represents 0.1% to 0.7% of cerebral aneurysms, and usually presents with compression of the brain stem or occlusion of penetrating branches; however, there are no reports of acute total occlusion of the basilar artery in a patient with the dolichoectatic aneurysm and no prodromal symptoms. Here, we report a case of a 60-year-old man presenting to our emergency department with acute vertigo and disturbance of consciousness. He had a medical history of hypertension that was being treated with antihypertensives, and had visited another center three years previously for evaluation of vertigo, and was diagnosed as dolichoectatic aneurysm of the basilar artery. As he had no symptoms other than vertigo, antihypertensives were prescribed for blood pressure control. A cranial CT scan revealed a mass lesion adjacent to the right pons. Digital subtraction angiography (DSA) showed accumulation of contrast material in the peripheral segment of the left vertebral artery, indicating total occlusion of the basilar artery. Endovascular treatment was performed, with intra-arterial urokinase injection and mechanical fragmentation of the thrombosis in the occluded segment of the main trunk of the basilar artery. However, it was not possible to reopen the basilar artery and the patient developed cerebellar infarction. We performed immediate surgical decompression and ventricular drainage; however, he died on day 9 after admission. To our knowledge, this is the first report of acute total basilar artery occlusion in a patient with dolichoectatic aneurysms.

A Case of a Dolichoectatic Aneurysm Presenting with Acute Total Basilar Artery Occlusion Following Hemorrhage in Thrombus