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

TL;DR

A rare case of a 51-year-old woman with vertebrobasilar dolichoectasia causing vertigo and weakness is reported, highlighting the importance of considering this condition in differential diagnoses.

Contribution

This case report adds to the limited literature on VBD presenting with atypical symptoms of vertigo and unilateral weakness.

Findings

CT angiography revealed a tortuous and dilated basilar artery in a patient with persistent vertigo and left-sided weakness.

The patient's symptoms were managed with antiplatelet therapy and meclizine, with no acute intervention required.

The case emphasizes the need to consider VBD in differential diagnoses despite its rarity and varied presentations.

Abstract

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.

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