[Repeated strokes in a patient with a basilar artery aneurysm]. / Ictus de repetición en paciente con aneurisma de la arteria basilar.

INTRODUCTION: The estimated prevalence of basilar dolichoectasia in the healthy general population is 50 per 100,000 inhabitants. The treatment of symptomatic cases is controversial. Strokes caused by it may be due to thrombosis of the perforating arteries, arterio-arterial emboli or a compressive mechanism. CLINICAL CASE: We present the case of a 68 year old woman with repeated stokes in which the vertebrobasilar territory was involved. On neuroimaging there was basilar dolichoectasia associated with aneurismal dilatation of both internal carotid arteries. The patient died of massive subarachnoid hemorrhage after starting heparin treatment. At necropsy the aneurysmic dilatation was confirmed together with signs of arteriosclerosis of the arteries of the circle of Willis. CONCLUSIONS: Since subarachnoid hemorrhage secondary to rupture of a dolichoectasia is exceptional, some authors support the use of permanent anticoagulation rather than platelet antiaggregation in patients with conditions due to ischemia, in which dilatation is limited to the basilar artery. However, this is not suitable for cases with associated fusiform aneuryms, or cases such as ours in which the dolichoectasia extends beyond the basilar artery, to become generalized throughout all the arteries of the circle of Willis.

Ictus de repetición en paciente con aneurisma de la arteria basilar / Repeated strokes in a patient with a basilar artery aneurysm

Introducción. La prevalencia estimada de la dolicoectasia basilar en la población general sana es de 50/100.000 habitantes. El tratamiento de los casos sintomáticos es discutido. Los ictus con este origen pueden ser debidos a trombosis de arterias perforantes, embolia arterio-arterial o a un mecanismo compresivo. Caso clínico. Presentamos el caso de una paciente de 68 años de edad que presentó ictus de repetición en el territorio vertebrobasilar, comprobándose en las pruebas de neuroimagen la presencia de una dolicoectasia basilar asociada a dilatación aneurismática de ambas arterias carótidas internas. La paciente falleció por hemorragia subaracnoidea masiva tras instaurar tratamiento con heparina. El estudio necrópsico confirmó la dilatación aneurismática con signos arterioscleróticos de las arterias del polígono de Willis. Conclusiones. Dada la excepcionalidad de una hemorragia subaracnoidea secundaria a la ruptura de una dolicoectasia, algunos autores defienden el uso de la anticoagulación permanente frente al de antiagregantes plaquetarios en los pacientes con patología isquémica, en los que la dilatación queda limitada a la arteria basilar. Sin embargo, no sería conveniente en los casos con aneurismas saculares asociados, o en los pacientes como el nuestro, en los que la dolicoectasia sobrepasa el territorio basilar para generalizarse a todas las arterias del polígono de Willis (AU)

[Dissection of the internal carotid artery with subarachnoid hemorrhage]. / Disección de la arteria carótida interna con hemorragia subaracnoidea.

INTRODUCTION: Dissection of the intracranial arteries is uncommon, forming less than 10% of all cranio-cervical dissections. Apart from the classical clinical findings of extracranial dissections, intracranial dissection may cause subarachnoid haemorrhage (SAH), mainly dissections involving the posterior circulation. CLINICAL CASE: We describe the case of a 49 year old man, a smoker, who had a sudden onset of headache followed by loss of consciousness. On CT there was SAH and multiple cerebral infarcts. Arteriography showed findings compatible with dissection of the extracranial and intracranial carotid arteries. DISCUSSION: We discuss the epidemiology and mechanisms of SAH associated with intracranial dissections. Intracranial dissection. Intracranial dissection should be considered in the differential diagnosis of SAH and of ischaemic syndromes.