Hemifacial spasm and recurrent stroke due to vertebrobasilar dolichoectasia coexisting with saccular aneurysm of the basilar artery: a case report.

We describe a patient presented with sequential events of hemifacial spasm, cerebral infarction and fatal subarachnoid hemorrhage. All of them are seemingly separate entities. Radiological examination revealed that the cause was vertebrobasilar dolichoectasia (VBD) coexisting with a giant saccular aneurysm of basilar artery. VBD is a dilatation and elongation of vertebral artery (VA) and basilar artery (BA) which is of different mechanism from saccular aneurysm. The condition is very rare and its progression may result in compression of brainstem and cranial nerves, ischemic and/or hemorrhagic stroke. The treatment of such condition is difficult and further research on the risk stratification of VBD for predicting stroke. Close monitoring and aggressive surgical interventions might be needed for high-risk patients.