P-OT006. Vertebro-basilar dolichoectasia: A case report of recurrent stroke with treatment dilemma

Abstract

Introduction. Vertebro-basilar dolichoectasia (VBD) has been associated with stroke and all- cause mortality. Subsequent stroke risk is also higher in patients with VBD. The incidence of the disease is low, and most patients are asymptomatic. Howbeit this disease carries significant mortality and disability rate in symptomatic patients. We report a case of recurrent ischemic stroke in a patient with VBD in Hospital Sultanah Maliha. Results. A 79-year-old man with underlying hypertension suffered from two strokes within six months duration. His first stroke was lacunar infarction with left hemiparesis and he was commenced on antiplatelet. He had modified Rankin Scale (mRS) score of 3 upon discharge. Six months later, he was readmitted for generalised tonic clonic seizure with worsening left hemiparesis. His computed tomography (CT) brain revealed hypodensity in right basal ganglia and right occipital, in line with recurrent ischemic stroke. His CT angiography of brain showed tortuous, elongated and dilated vertebral and basilar arteries with wall calcification which are consistent with VBD. Family members opted for conservative management and he was discharged with mRS score of 5. Discussion. VBD is recognized as an important independent risk factor for recurrent stroke. There are currently no effective measures to manage patients with VBD who present with ischemic symptoms. Dolichoectasia is an arteriopathy rather than an atherosclerosis; thus, the role of antiplatelet or anticoagulant therapy is unclear, but it may increase the risk of VBD rupture. Conclusion. VBD is considered a challenging lesion without an ideal treatment modality. Despite the unfavourable course of VBD, there is still uncertainty in the optimal treatment of VBD.