Megadolichobasilar anomaly associated with subarachnoid hemorrhage-A case report

• Published in: Japanese Journal of Stroke Vol. 13; no. 5; pp. 394 - 399
• Main Authors: Yamakami, Iwao, Isobe, Katsumi
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 1991
• Subjects: cerebral arterial ectasia; megadolichobasilar anomaly; subarachnoid hemorrhage
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.13.394

An abnormal elongation, widening and tortuosity of the basilar artery are a well-recognized clinical entity, called as megadolichobasilar anomaly (MBA), which usually causes either ischemic events of the posterior circularion or compression of the adjacent nerve tissue. Subarachnoid hemorrhage (SAH) resulting from its rupture is a rare complication of MBA. We report a fifty-five year old man who had recurrent SAH resulting from repeated ruptures of MBA. The patient who had been treated with antihypertensive agents for fifteen years was admitted on October 26, 1989. He was stuporous and had a mild nuchal rigidity. Plain CT scan showed a SAH mainly in the posterior fossa which refluxed in the fourth ventricle. CT scan with contrast medium revealed a large tubular, tortuous enhancement around the medulla and pons. Cerebral angiography demonstrated MBA associated with multiple saccular aneurysms of the left posterior cerebral artery, left middle cerebral artery and right anterior cerebral artery. The site of SAH strongly suggested that SAH was resulting from the rupture of MBA. In spite of the medical and surgical (ventricular drainage and ventriculo-peritoneal shunt) treatment, he deteriorated progressively resulting from repeated SAH and died on December 25, 1989. None has reported a case of MBA associated with SAH and treated with a direct surgery for the ruptured anomaly. However, our case who died of repeated ruptures of MBA suggested a necessity of surgical treatment of this clinical entity. The combination of proximal ligation of vertebral artery and occipital artery-poterior inferior cerebellar artery (OA-PICA) bypass surgery may change the hemodynamics of MBA and prevent the recurrence of SAH.