Case report: Intracranial Arterial Dolichoectasia

Intracranial arterial dolichoectasia (IADE) is a diameter increase and/ or a long and tortuous path in one or more Intracranial arterial. Most patients keep asymptomatic and eventually present neurological complications (ischemia, bleeding or compression of adjacent structures). At around 12% of the patients with stroke present this kind of intracranial dilated, which 80% are in the posterior cerebral circulation, mainly in basilar artery. Objective: Report an unusual case of IADE refractory to the clinical treatment. Method: The information was obtained by reviewing the medical record, after the patient’s consent. Result: Patient, 51, male, hypertensive and dyslipidemic, with abdominal aortic aneurysm surgery and an incidental diagnosis in 2015 of fusiform basilar artery aneurysm, presented in March 2020 after cervical flexion, dysarthria, horizontal diplopia when looking to the right and ptosis to the left. The computed cranial angiotomography showed a basilar artery of 1.8 cm diameter fusiform aneurysm, compressing the pons and medulla oblongata, with no signs of ischemia or bleeding. He was discharged from hospital with clopidogrel without deficits, however, after 30 days, manifested a new focal neurological deficit with spontaneous remission. During the investigation a skull resonance was presented without ischemia, transcranial doppler with circulatory delay and without embolization. In view of the recurrence, an exchange in clopidogrel for ticagrelor was decided, which was kept stable for 30 days. Conclusion: IADE may be an incidental finding or even a life-threatening illness. Thus, these cases remain a major challenge in clinical practice and in interventional radiology.