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[Clinicopathoradiological studies in 15 cases of megadolichobasilar anomaly]
Insights
Megadolichobasilar anomalies, characterized by elongated and widened basilar arteries, are associated with severe neurological symptoms and poor outcomes. This study highlights the critical need for early diagnosis and management of these rare vascular conditions.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroradiology
Background:
- Megadolichobasilar anomaly (MDBA) is a rare condition involving abnormal elongation and widening of the basilar artery.
- Clinical presentation often includes ischemic events, headaches, or trigeminal neuralgia.
- Severe hypertension is a common comorbidity.
Observation:
- This study assessed 15 patients with angiographically diagnosed MDBA.
- Patients averaged 61 years old, with a slight male predominance (9 males, 6 females).
- Common symptoms included cerebral ischemic attacks (11 patients), trigeminal neuralgia (2 patients), and severe headaches (2 patients).
Findings:
- Vertebral angiography revealed marked basilar artery elongation, tortuosity, and dilatation (average diameter 8.6 mm).
- CT scans showed a characteristic tubular, contrast-enhancing high-density mass.
- Four patients exhibited aneurysmal dilatation of the basilar artery.
Implications:
- MDBA is associated with a high rate of severe morbidity and mortality.
- Poor outcomes included 5 deaths and 4 cases of severe dementia among the 15 patients.
- Findings underscore the importance of recognizing MDBA for appropriate clinical management and prognosis.
Abstract:
We clinicopathoradiologically assessed 15 angiographically diagnosed megadolichobasilar anomalies. Nine of the patients were male and 6 were female; their average age was 61 years. Eleven patients presented with cerebral ischemic attacks, other two complained of trigeminal neuralgia and the remaining two suffered severe headaches. Twelve of the patients had severe hypertension. Vertebral angiography revealed marked elongation of the basilar artery with severe tortuousity and dilatation. The average distance from the dorsum sellae to the basilar artery bifurcation on the lateral view was 24.7 mm, and the average maximum diameter of the basilar artery was 8.6 mm. Aneurysmal dilatation of the basilar artery was also observed in four cases. In 14 of the 15 patients CT scans revealed characteristic findings, such as tubular high density mass with evident contrast enhancement extending from the ventral medulla to the interpeduncular cistern. The outcome was extremely poor, with five deaths and four patients with severe dementia. In the two autopsy cases, enlarged internal lumens could be observed despite severe atheroscrelotic changes, such as intimal thickening by atheromas.