A case with megadolicho-basilar artery manifesting as anterior inferior cerebellar artery(AICA) syndrome due to its dissecting aneurysm.

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A hypertensive 64-year-old man had once experienced vertigo and tinnitus at right side and had been diagnosed to have megadolicho-basilar artery (MDBA) by CT scan and cerebral angiography. He was admitted to our hospital because of sudden vertigo and worsening of the tinnitus. Neurological examination revealed rotatory nystagmus, right peripheral facial palsy, right hearing loss accompanied by tinnitus, soft palate paralysis at the left side, tongue deviation to the left, quadriparesis (mainly right hemiparesis), and left hemisensory disturbance.<BR>CT scan showed markedly tortuous and extended basilar artery which oppressed basis pontis. A T2 weighted magnetic resonance imaging (MRI) demonstrated high intensity area at the cerebellum along the teritory of right anterior inferior cerebellar artery (AICA). T1 weighted MRI distinguished a thrombus (high T2 area) from a vascular space (flow void) within the basilar artery.<BR>Although angiography showed no evidence of a double lumen or a narrowed tapering of the basilar artery, meaning the true diagnostic sign of a "dissection", retention of contrast medium was recognized in the basilar artery at a venous phase, which indicated the dissecting space of the basilar artery.<BR>MDBA complicated by dissecting aneurysm had not been previously reported. Arteriosclerotic change of the wall might have a common effect to cause both MDBA and dissecting aneurysm.
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