From the Istituto di Clinica delle Malattie Nervose e Mentali (S.P.) and
Istituto di Scienze Eidologiche e Radiologiche (G.F.), Università di
Siena (Italy).
Correspondence to Stefano Passero, MD, Istituto di Clinica delle Malattie Nervose e Mentali, Università di Siena, Viale Bracci, I-53100 Siena, Italy.
Background and
Purpose—Vertebrobasilar dolichoectasia (VBD) may produce symptoms
by direct compression of cranial nerves or the brain stem, by
obstructive hydrocephalus, or by ischemia in the
vertebrobasilar arterial territory. This study was
undertaken to examine and characterize clinical and imaging findings in
patients with stroke associated with VBD and compare these data with
those for patients with VBD who did not have a stroke.
Methods—We studied 40 consecutive stroke patients with associated
VBD. All were evaluated by CT scan (n=9), MRI (n=6), or both (n=25).
The diameter of the basilar artery (BA), height of bifurcation, and
transverse position were evaluated. Clinical and imaging findings were
compared with those found in a group of 40 VBD patients without stroke.
Results—More than half of the patients (24 of 40) had
infratentorial infarcts, located mainly in the midpons. Sixteen
patients had supratentorial lesions localized in
the thalamus (n=8) or in the superficial arterial territory
of the posterior cerebral artery (PCA; n=8). The diameter and height of
the bifurcation of the BA were correlated with the location of the
lesion (PCA territory versus BA territory), in that severe ectasia and
vertical elongation of the BA were significantly more often observed in
patients with infarcts in PCA territory than in patients with infarcts
in territories supplied by branches of the BA. Comparison of VBD
patients with and without stroke showed that the incidence of
arterial hypertension and the degree of ectasia and lateral
displacement of the BA were not significantly different in the two
groups. Patients with stroke more often had atherosclerotic changes of
the posterior circulation (P=.0006) and a higher degree
of vertical elongation of the BA (P=.025).
Conclusions—In patients with VBD, superimposed
atheromatous changes of the posterior circulation may
have an important role in precipitating ischemia. However,
other factors related to the severity of the dolichoectasia also favor
ischemia and in some cases are the only factors responsible.
© 1998 American Heart Association, Inc.
Original Contributions
Posterior Circulation Infarcts in Patients With Vertebrobasilar Dolichoectasia
Key Words: stroke, ischemic • vertebrobasilar circulation • vertebrobasilar dolichoectasia
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