Ectasia da artéria basilar e acidente vascular cerebral: aspectos clínicos de 21 casos

Oliveira, Roberto de Magalhães Carneiro de; Cardeal, José Osmar; Lima, José Geraldo de Camargo

doi:10.1590/S0004-282X1997000400007

Resumos

A ectasia da artéria basilar (EB) é a dilatação do calibre em toda ou parte de sua extensão, e/ou quando for anormalmente tortuosa em seu trajeto. As manifestações clínicas são decorrentes de compressão de nervos cranianos, fenômeno isquêmico ou hemorrágico, síndrome de pseudo-tumor ou hidrocefalia. Procuramos descrever casos da associação de EB e acidente vascular cerebral (AVC), analisar sua frequência, aspectos clínicos e os mecanismos envolvidos nas diferentes formas de apresentação clínica desta entidade. Encontramos 21 pacientes com AVC e EB. A associação de EB e AVC foi prevalente em indivíduos do sexo masculino após 50 anos. Os principais sintomas observados foram hemiparesia, alteração de nervos cranianos e ataxia cerebelar. Na instalação do AVC foram importantes as tonturas rotatórias e a cefaléia. Os infartos relacionados à EB puderam ser atribuídos a diferentes mecanismos: trombose da artéria, embolia artério-arterial, efeito de massa com angulação e obstrução de ramos das artérias vertebrais e basilar.

acidente vascular cerebral; ectasia; insuficiência vértebro-basilar

Ectasia of the basilar artery (EB) occurs when its diameter is greater than normal along all or part of its course, and/or when it is abnormally tortuous. EB may cause cranial nerve dysfunction, ischemic stroke or subarachnoid hemorrhage, pseudotumor or hydrocephalus. We tried to describe cases of stroke associated with EB, analyze its frequency, clinical aspects, and the mechanisms involved in different forms of its presentation. We found 21 patients with stroke and EB. The association between EB and stroke was more prevalent in males over the age of fifty. Main symptoms were hemiparesia, cranial nerves dysfunction, and cerebellar ataxia. Cerebral infarcts associated with EB were due to different mechanisms: arterial thrombosis, artery-to-artery embolism, mass effect with angulation and obstruction of the vertebral and basilar branches.

cerebrovascular disorder; vertebrobasilar insufficiency; ectasia

Ectasia da artéria basilar e acidente vascular cerebral: aspectos clínicos de 21 casos

Basilar ectasia and stroke: clinical aspects of 21 cases

Roberto de Magalhães Carneiro de Oliveira^I; José Osmar Cardeal^II; José Geraldo de Camargo Lima^III

^IDisciplina de Neurologia da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina: Pós graduando

^IIDisciplina de Neurologia da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina: Professor Adjunto

^IIIDisciplina de Neurologia da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina: Professor Titular (aposentado)

RESUMO

A ectasia da artéria basilar (EB) é a dilatação do calibre em toda ou parte de sua extensão, e/ou quando for anormalmente tortuosa em seu trajeto. As manifestações clínicas são decorrentes de compressão de nervos cranianos, fenômeno isquêmico ou hemorrágico, síndrome de pseudo-tumor ou hidrocefalia. Procuramos descrever casos da associação de EB e acidente vascular cerebral (AVC), analisar sua frequência, aspectos clínicos e os mecanismos envolvidos nas diferentes formas de apresentação clínica desta entidade. Encontramos 21 pacientes com AVC e EB. A associação de EB e AVC foi prevalente em indivíduos do sexo masculino após 50 anos. Os principais sintomas observados foram hemiparesia, alteração de nervos cranianos e ataxia cerebelar. Na instalação do AVC foram importantes as tonturas rotatórias e a cefaléia. Os infartos relacionados à EB puderam ser atribuídos a diferentes mecanismos: trombose da artéria, embolia artério-arterial, efeito de massa com angulação e obstrução de ramos das artérias vertebrais e basilar.

Palavras-chave: acidente vascular cerebral, ectasia, insuficiência vértebro-basilar.

ABSTRACT

Ectasia of the basilar artery (EB) occurs when its diameter is greater than normal along all or part of its course, and/or when it is abnormally tortuous. EB may cause cranial nerve dysfunction, ischemic stroke or subarachnoid hemorrhage, pseudotumor or hydrocephalus. We tried to describe cases of stroke associated with EB, analyze its frequency, clinical aspects, and the mechanisms involved in different forms of its presentation. We found 21 patients with stroke and EB. The association between EB and stroke was more prevalent in males over the age of fifty. Main symptoms were hemiparesia, cranial nerves dysfunction, and cerebellar ataxia. Cerebral infarcts associated with EB were due to different mechanisms: arterial thrombosis, artery-to-artery embolism, mass effect with angulation and obstruction of the vertebral and basilar branches.

Key-words: cerebrovascular disorder, vertebrobasilar insufficiency, ectasia.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 5-maio-1997.

Dr. Roberto de Magalhães Carneiro de Oliveira - Disciplina de Neurologia, Escola Paulista de Medicina - Rua Botucatu 762 - 04023-900 São Paulo SP - Brasil.

1. Boeri R, Passeríni A. The megadolichobasilar anomaly. J Neurol Sci 1964;1:475-484.
2. Brichaux JC, Gense D, Greselle JF, Jasek F, Bouin H, Caillé JM. Problèmes radiocliniques posés par les méga-dolicho trones basilaires: à propos de 17 observations et revue de la littérature. J Neuroradiol 1989;16:11-24.
3. Campbell E, Keedy C. Hemifacial spasm: a note on the etiology in two cases. J Neurosurg 1947;4:342-347.
4. Echiverri HC, Rubino FA, Gupta SR, Gujrati M. Fusiform aneurysm of the vertebrobasilar arterial system. Stroke 1989;20:1741-1747.
5. Frasson F, Ferrari G, Fiaschi A. Megadolichobasilar anomaly causing brainstem syndrome. Neuroradiology 1977;13:279-281.
6. Gautier JC, Hauw JJ, Awada A, Loron P, Gray F, Juillard JB. Artères cérébrales dolichoectasiques: association aux anévrysmes de l'aorte abdominale. Rev Neurol (Paris) 1988,144:437-446.
7. Hassler O. Morphological studies on the large cerebral arteries with reference to the aetiology of subarachnoid haemorrhage. Acta Psychiatr Neurol Scand 1961;36(Suppl 154):5-145.
8. Hatano S. Experience from a multicenter stroke register: a preliminary report. Bull World Health Organ 1976;54:541-553.
9. Hegedus K. Ectasia of the basilar artery with special reference to possible pathogenesis. Surg Neurol 1985;24:463-469.
10. Herpers M, Lodder J, Janevski B, Van Der Lugt PJM. The symptomatology of the megadolicho basilar artery. Clin Neurol Neurosurg 1983;85:203-212.
11. Hirsch CS, Roessmann U. Arterial dysplasia with ruptured basilar artery aneurysm: report of a case. Hum Pathol 1975;6:749-758.
12. Johnsen SD, Okamoto G, Kooiker J. Fusiform basilar artery aneurysm in a child. Neurology 1977;27:334-336.
13. Lodder J, Janevski B, Van Der Lugt PJM. Megadolicho vascular malformation of the intracranial arteries. Clin Neurol Neurosurg 1981;83:11-18.
14. Maisey DN, Cosh JA. Basilar artery aneurysm and Anderson-Fabry disease. J Neurol Neurosurg Psychiatry 1980;43:85-87.
15. Makos MM, McComb RD, Hart MN, Bennett DR. Alpha-glucosidase deficiency and basilar artery aneurysm: report of a sibship. Ann Neurol 1987;22:629-633.
16. Milandre L, Bonnefoi B, Pestre P, Pellissier JF, Grisoli F, Khalil R. Dolichoectasies artérielles vertébrobasilaires: complications et prognostic. Rev Neurol (Paris) 1991;147:714-722.
17. Moseley I F, Holland IM. Ectasia of the basilar artery: the breadth of the clinical spectrum and the diagnostic value of computed tomography. Neuroradiology 1979;18:83-91.
18. Nijensohn DE, Saez RJ, Reagan TJ. Clinical significance of basilar artery aneurysms. Neurology 1974;24:301-305.
19. Nishizaki T, Tamaki N, Takeda N, Shirakuni T, Kondoh T, Matsumoto S. Dolichoectatic basilar artery: a review of 23 cases. Stroke 1986;17:1277-1281.
20. Pessin M S, Chimowitz MI, Levine SR, Kwan E S, Adelman LS, Earnest MP, Clark DM, Chason J, Austrian JI, Caplan LR. Stroke in patients with fusiform vertebrobasilar aneurysms. Neurology 1989;39:16-21.
21. Peterson NT, Duchesneau PM, Westbrook EL, Weinstein MA. Basilar artery ectasia demonstrated by computed tomography. Radiology 1977;122:713-715.
22. Read D, Esiri MM. Fusiform basilar artery aneurysm in a child. Neurology 1979;29:1045-1049.
23. Sacks JG, Lindenberg R. Symptomatology and pathology of arterial elongation and distention. Hopkins Med J 1969;125:95-106.
24. Scotti G, De Grandi C, Colombo A. Ectasia of the intracranial arteries diagnosed by computed tomography: megadolichobasilar artery CT diagnosis. Neuroradiology 1978;15:183-184.
25. Smoker WR, Price MJ, Keyes WD, Corbett JJ, Gentry LR. High-resolution computed tomography of the basilar artery:1. Normal size and position. AJNR 1986;7:55-60.
26. Smoker WR, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S. High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review. AJNR 1986;7:61-72.
27. Wallace S, Jaffe ME. Cerebral arterial ectasia with saccular aneurysms. Radiology 1967;88:90-93.
28. Watanabe T, Sato K, Yoshimoto T. Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery. Stroke 1994;25:1068-1070.
29. Whisnant JP, Basford JR, Bernstein EF, et al.. Classification of cerebrovascular disease III. Stroke 1990;21:637-676.
30. Yu Y, Moseley I, Pullicino P, McDonald W. The clinical picture of ectasia of the intracerebral arteries. J Neurol Neurosurg Psychiatry 1982;45:29-36.

Datas de Publicação

Publicação nesta coleção
18 Out 2010
Data do Fascículo
Set 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Boeri R, Passeríni A. The megadolichobasilar anomaly. J Neurol Sci 1964;1:475-484.

[2] 2. Brichaux JC, Gense D, Greselle JF, Jasek F, Bouin H, Caillé JM. Problèmes radiocliniques posés par les méga-dolicho trones basilaires: à propos de 17 observations et revue de la littérature. J Neuroradiol 1989;16:11-24.

[3] 3. Campbell E, Keedy C. Hemifacial spasm: a note on the etiology in two cases. J Neurosurg 1947;4:342-347.

[4] 4. Echiverri HC, Rubino FA, Gupta SR, Gujrati M. Fusiform aneurysm of the vertebrobasilar arterial system. Stroke 1989;20:1741-1747.

[5] 5. Frasson F, Ferrari G, Fiaschi A. Megadolichobasilar anomaly causing brainstem syndrome. Neuroradiology 1977;13:279-281.

[6] 6. Gautier JC, Hauw JJ, Awada A, Loron P, Gray F, Juillard JB. Artères cérébrales dolichoectasiques: association aux anévrysmes de l'aorte abdominale. Rev Neurol (Paris) 1988,144:437-446.

[7] 7. Hassler O. Morphological studies on the large cerebral arteries with reference to the aetiology of subarachnoid haemorrhage. Acta Psychiatr Neurol Scand 1961;36(Suppl 154):5-145.

[8] 8. Hatano S. Experience from a multicenter stroke register: a preliminary report. Bull World Health Organ 1976;54:541-553.

[9] 9. Hegedus K. Ectasia of the basilar artery with special reference to possible pathogenesis. Surg Neurol 1985;24:463-469.

[10] 10. Herpers M, Lodder J, Janevski B, Van Der Lugt PJM. The symptomatology of the megadolicho basilar artery. Clin Neurol Neurosurg 1983;85:203-212.

[11] 11. Hirsch CS, Roessmann U. Arterial dysplasia with ruptured basilar artery aneurysm: report of a case. Hum Pathol 1975;6:749-758.

[12] 12. Johnsen SD, Okamoto G, Kooiker J. Fusiform basilar artery aneurysm in a child. Neurology 1977;27:334-336.

[13] 13. Lodder J, Janevski B, Van Der Lugt PJM. Megadolicho vascular malformation of the intracranial arteries. Clin Neurol Neurosurg 1981;83:11-18.

[14] 14. Maisey DN, Cosh JA. Basilar artery aneurysm and Anderson-Fabry disease. J Neurol Neurosurg Psychiatry 1980;43:85-87.

[15] 15. Makos MM, McComb RD, Hart MN, Bennett DR. Alpha-glucosidase deficiency and basilar artery aneurysm: report of a sibship. Ann Neurol 1987;22:629-633.

[16] 16. Milandre L, Bonnefoi B, Pestre P, Pellissier JF, Grisoli F, Khalil R. Dolichoectasies artérielles vertébrobasilaires: complications et prognostic. Rev Neurol (Paris) 1991;147:714-722.

[17] 17. Moseley I F, Holland IM. Ectasia of the basilar artery: the breadth of the clinical spectrum and the diagnostic value of computed tomography. Neuroradiology 1979;18:83-91.

[18] 18. Nijensohn DE, Saez RJ, Reagan TJ. Clinical significance of basilar artery aneurysms. Neurology 1974;24:301-305.

[19] 19. Nishizaki T, Tamaki N, Takeda N, Shirakuni T, Kondoh T, Matsumoto S. Dolichoectatic basilar artery: a review of 23 cases. Stroke 1986;17:1277-1281.

[20] 20. Pessin M S, Chimowitz MI, Levine SR, Kwan E S, Adelman LS, Earnest MP, Clark DM, Chason J, Austrian JI, Caplan LR. Stroke in patients with fusiform vertebrobasilar aneurysms. Neurology 1989;39:16-21.

[21] 21. Peterson NT, Duchesneau PM, Westbrook EL, Weinstein MA. Basilar artery ectasia demonstrated by computed tomography. Radiology 1977;122:713-715.

[22] 22. Read D, Esiri MM. Fusiform basilar artery aneurysm in a child. Neurology 1979;29:1045-1049.

[23] 23. Sacks JG, Lindenberg R. Symptomatology and pathology of arterial elongation and distention. Hopkins Med J 1969;125:95-106.

[24] 24. Scotti G, De Grandi C, Colombo A. Ectasia of the intracranial arteries diagnosed by computed tomography: megadolichobasilar artery CT diagnosis. Neuroradiology 1978;15:183-184.

[25] 25. Smoker WR, Price MJ, Keyes WD, Corbett JJ, Gentry LR. High-resolution computed tomography of the basilar artery:1. Normal size and position. AJNR 1986;7:55-60.

[26] 26. Smoker WR, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S. High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review. AJNR 1986;7:61-72.

[27] 27. Wallace S, Jaffe ME. Cerebral arterial ectasia with saccular aneurysms. Radiology 1967;88:90-93.

[28] 28. Watanabe T, Sato K, Yoshimoto T. Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery. Stroke 1994;25:1068-1070.

[29] 29. Whisnant JP, Basford JR, Bernstein EF, et al.. Classification of cerebrovascular disease III. Stroke 1990;21:637-676.

[30] 30. Yu Y, Moseley I, Pullicino P, McDonald W. The clinical picture of ectasia of the intracerebral arteries. J Neurol Neurosurg Psychiatry 1982;45:29-36.