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Images in Neurology | February 25, 2013

Successful Repetitive Intravenous Thrombolysis in a Patient With Recurrent Brainstem Infarctions Due to Megadolichobasilar Ectasia

Melissa Cambron, MD; Robbert-Jan Van Hooff, MD; Koenraad Nieboer, MD; Jacques De Keyser, MD, PhD; Raf Brouns, MD, PhD

JAMA Neurol. 2013;70(4):520-521. doi:10.1001/jamaneurol.2013.618.

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Megadolichobasilar ectasia is defined as marked elongation, widening, and tortuosity of the basilar artery.¹ Intracranial dolichoectasia is associated with an increased risk of ischemic and hemorrhagic stroke and is found in 10% to 12% of patients with stroke.² Intravenous (IV) administration of recombinant tissue plasminogen activator (rtPA) is the only approved therapy for acute ischemic stroke³ but is contraindicated in patients with increased risk of intracranial hemorrhage. Data on the bleeding risk in patients with megadolichobasilar ectasia treated with IV rtPA are nonexistent.

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Figure 1. Volume rendering reconstruction of computed tomographic angiography of the intracranial arteries projected on the skull base, viewed from above and behind. The left vertebral artery is markedly looped and ectatic. The basilar artery is severely dilated (maximal diameter of 26 mm) and has a prolonged course over the lateral margin of the clivus projecting its tip well above the dorsum sellae.

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Figure 2. Postgadolinium coronal T1-weighted spin-echo magnetic resonance image showing a large residual mural thrombus in the midsection of the basilar artery (arrow).

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Cambron M, Van Hooff R, Nieboer K, De Keyser J, Brouns R. Successful Repetitive Intravenous Thrombolysis in a Patient With Recurrent Brainstem Infarctions Due to Megadolichobasilar Ectasia. JAMA Neurol. 2013;70(4):520-521. doi:10.1001/jamaneurol.2013.618.

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