[Repeated strokes in a patient with a basilar artery aneurysm]

The estimated prevalence of basilar dolichoectasia in the healthy general population is 50 per 100,000 inhabitants. The treatment of symptomatic cases is controversial. Strokes caused by it may be due to thrombosis of the perforating arteries, arterio-arterial emboli or a compressive mechanism.

We present the case of a 68 year old woman with repeated stokes in which the vertebrobasilar territory was involved. On neuroimaging there was basilar dolichoectasia associated with aneurismal dilatation of both internal carotid arteries. The patient died of massive subarachnoid hemorrhage after starting heparin treatment. At necropsy the aneurysmic dilatation was confirmed together with signs of arteriosclerosis of the arteries of the circle of Willis.

Since subarachnoid hemorrhage secondary to rupture of a dolichoectasia is exceptional, some authors support the use of permanent anticoagulation rather than platelet antiaggregation in patients with conditions due to ischemia, in which dilatation is limited to the basilar artery. However, this is not suitable for cases with associated fusiform aneuryms, or cases such as ours in which the dolichoectasia extends beyond the basilar artery, to become generalized throughout all the arteries of the circle of Willis.