[Megadolicho basilar artery as indication of intensive care relevant vertebrobasilar ischemia].

An ectasia and enlargement of the basilar artery by a fusiform aneurysm is called megadolicho basilaris. We report five cases with this condition identified at our clinic since 1989, reflecting an incidence of 0.05 percent (5/9300 scans). All patients presented with an acute brainstem syndrome (medullary in 2, pontine in 1 and pontomedullary in 2 patient). With one exception, all cases required intensive care due to respiratory insufficiency. Two patients died, one required total care, and two patients made a good recovery, one of these under therapeutic anticoagulation. All but one patient experienced additional episodes of cerebrovascular ischemia before or after presentation. Vascular risk factors were found in four patients. The detection of a megadolicho basilaris identifies a patient subgroup that is highly prone to vertebrobasilar ischemia and therefore of high significance for neurological intensive care medicine. Recurrence rate for ischemia is high. While even a severe brainstem syndrome may be reversed under anticoagulation in the individual case, presence of multiple vascular risk factors often prevents the employment of this treatment modality.