Dolichoectasia Involving Both Anterior and Posterior Circulations: A ‍Case Report and Literature Review

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Transient ischemic attack (TIA) can have diverse etiologies.
• Cerebral artery dolichoectasia, characterized by abnormal vessel dilation, is a recognized but less common cause of neurological events.
• Dolichoectasia predominantly affects the posterior circulation, with anterior circulation involvement being rarer.

Purpose of the Study:

• To report a rare case of TIA secondary to combined anterior and posterior circulation dolichoectasia.
• To emphasize the importance of considering dolichoectasia in the differential diagnosis of TIA, particularly with atypical neuroimaging findings.
• To highlight the diagnostic challenges and potential therapeutic considerations in such cases.

Main Methods:

• Case report of a 79-year-old woman presenting with transient left upper limb weakness.
• Neuroimaging including Brain MRI, Magnetic Resonance Angiography (MRA), and contrast-enhanced CT.
• Clinical diagnosis of TIA based on presentation and neuroimaging findings.

Main Results:

• Brain MRI revealed acute infarction in the right caudate nucleus and multiple old microbleeds.
• MRA and contrast-enhanced CT demonstrated extensive fusiform dilatation (dolichoectasia) of supraclinoid internal carotid arteries, middle cerebral arteries, and posterior circulation.
• The patient was diagnosed with TIA, and antithrombotic therapy was withheld due to concurrent chronic subdural hematomas and cerebral microbleeds.

Conclusions:

• This case illustrates a rare instance of dolichoectasia affecting both anterior and posterior cerebral circulations, leading to TIA.
• Cerebral artery dolichoectasia should be included in the differential diagnosis for TIA, especially when neuroimaging shows abnormal vascular morphology.
• Further case accumulation is necessary to understand the mechanisms and optimize treatment for this rare vascular condition.