Cerebellar and brainstem infarction secondary to basilar artery dolichoectasia

Vertebrobasilar dolichoectasia (VBD) is a rare condition characterized by a significant dilation, elongation and tortuosity of the arteries emerging from the vertebrobasilar system. In this study, we report a 57-year-old male, with medical history of recurrent migraines and right peroneal nerve palsy, which presents the sudden onset of clinical signs of brainstem and cerebellar stroke. The brain CT scan revealed an inhomogeneous, hyperdense prepontine lesion, situated in the area of basilar artery (BA) projection. The cerebral angiography showed in the V4 segment of the left vertebral artery (VA) a focal, concentric stenosis of 70%, followed by a fusiform dilation extended to the BA bifurcation, a saccular aneurysmal dilation in the communicant segment of the internal carotid artery and tortuous trajectory of the abdominal and thoracic aorta, including the supra-aortic vessels. The brain MRI revealed a bulbopontin and left cerebellum infarction. Patient developed at 48 hours after hospitalization livedo reticularis at the level of the right thoracic wall and thighs. The nerve conduction studies revealed mononeuritis multiplex. The vascular anomaly that was identified in the presented case respects the criteria for a VBD, however the involvement of the aorta with the presence of tortuosities, the simultaneous presence of the internal carotid artery aneurysm, together with the presence of the mononeuritis multiplex and the skin condition (livedo reticularis) suggest the possibility of coexistence of a systemic vasculitis, possible polyarteritis nodosa