Vertebrobasilar artery ectasia presenting as hydrocephalus

Obstructive hydrocephalus typically results from physical blockage of cerebrospinal fluid flow. Normal pressure hydrocephalus is a known cause of gait disturbance, dementia, and urinary incontinence. Prior research has shown that ventricular obstruction can arise from various anatomical anomalies. However, basilar artery ectasia as a cause remains underreported. This gap motivated a closer examination of rare vascular contributions to hydrocephalus. No prior work had resolved how ectatic arteries might compress ventricular structures. The classical triad of symptoms is often linked to known pathologies. This case introduces a novel vascular mechanism for obstructive hydrocephalus.

The aim of this case report is to highlight an unusual cause of obstructive hydrocephalus. The specific problem involves a rare vascular anomaly mimicking a common neurological syndrome. The motivation stems from the need to expand diagnostic considerations in elderly patients. The patient presented with progressive dementia and gait issues. These symptoms align with normal pressure hydrocephalus but lack a clear etiology. The study seeks to describe the intersection of cerebrovascular and hydrocephalus pathology. Ventricular obstruction due to basilar artery ectasia is the focus. This case aims to inform clinical suspicion in atypical presentations.

The study involved clinical evaluation and neuroimaging of an 81-year-old woman. Computed tomography and magnetic resonance imaging were used to assess brain structure. Findings revealed a large ectatic basilar artery compressing the fourth ventricle. Ventriculoperitoneal shunting was performed to address obstructive hydrocephalus. Post-operative clinical outcomes were monitored to assess treatment efficacy. The patient’s rapid symptom resolution was documented. No additional interventions were required following the shunt placement. This approach allowed for direct correlation between imaging findings and clinical response.

Brain imaging showed obstruction of the fourth ventricle caused by a large ectatic basilar artery. The patient exhibited the classical triad of normal pressure hydrocephalus symptoms. Ventriculoperitoneal shunting led to rapid resolution of gait disturbance and incontinence. Dementia symptoms also improved following the procedure. No complications were reported from the shunting intervention. The ectatic artery remained unchanged post-operatively. The patient’s clinical response confirmed the diagnosis of obstructive hydrocephalus. This case demonstrates a rare vascular cause of ventricular obstruction.

The authors propose that basilar artery ectasia can compress the fourth ventricle, mimicking normal pressure hydrocephalus. This case illustrates a rare but treatable cause of obstructive hydrocephalus. The rapid clinical improvement following shunting supports this mechanism. The study does not suggest basilar artery ectasia as a common cause of hydrocephalus. The findings are specific to this patient’s anatomical anomaly. The authors do not generalize this mechanism to other cases of hydrocephalus. The case highlights the importance of imaging in diagnosing rare vascular causes. The authors do not claim this is a frequently encountered condition.