Vertebrobasilar Dolichoectasia Presenting as Vertigo and Unilateral Weakness: A Case Report

Vertebrobasilar dolichoectasia (VBD) is a rare condition characterized by dilated and tortuous basilar and/or vertebral arteries. It can be asymptomatic or present as an ischemic stroke, hemorrhage, brainstem/cranial nerve compression, or hydrocephalus. We present a case of a 51-year old woman with a history of transient ischemic attack who presented with persistent vertigo and left-sided weakness and numbness for multiple days. Physical exam was remarkable for the findings of central vertigo and left-sided impairment in sensation and strength. While computed tomography (CT) and magnetic resonance imaging were unremarkable, CT angiography showed a tortuous and dilated basilar artery to 4.9 mm, likely the underlying cause of her symptoms. She was continued on her home aspirin, clopidogrel, and high-intensity atorvastatin and started on meclizine for symptomatic management of vertigo. Although rare, VBD should remain on the differential diagnosis for a variety of patient presentations, especially given its poor prognosis in symptomatic patients.