[A case of internal carotid dolichoectasia]

A 50-year-old woman noticed right motor and sensory paralysis in the morning of December 15, 1978, which improved gradually to be able to walk during 20 days. She had recurrence of incomplete paralysis of right extremities with speech disturbance and admitted to our department on April 7. Neurological examination revealed right hemiparesis. Plain skull rentogenorgram showed a calcification extending posteriorly from the left anterior clinoid process. CT scan showed a mass lesion located at the left frontal lobe to the ambient cistern. The mass lesion showed high density, but its midportion was isodensity. The left carotid angiogram demonstrated abnormally curved, tortuous and dilated internal carotid artery at the intracavernous portion (C3) to bifurcation (C1). The cerebral circulation time was greatly delayed, which regained about 6 seconds for the visualization of the distal portion of the middle cerebral artery. On the basis of the above, we considered that the first right hemiparesis was due to emboli produced in the dolichoectasia and the following progressive stroke was attributable to the low perfusion demonstrated by a great delay of circulation time. The operation was performed to trap the dolichoectasia after STA-MCA anastomosis. However, trapping procedure was very difficult because of hardness of the distal portion of the involved artery. Therefore, surgery was concluded with STA-MCA anastomosis and only proximal internal carotid clipping. The postoperative angiography demonstrated well functional anastomosis and obliteration of dolichoectasia. She discharged on improvement of her condition on the 23rd day after operation. CT scan performed 6 months after operations showed the mass lesion to have become definitely reduced in size. The application of bypass surgery to the internal carotid dolichoectasia was reported with review of the literatures.