Vertebrobaziler arter dolikoektazisi ve ağrı; ko-insidans mı, nedensellik mi?

Dolikoektazi arterlerin uzaması, genişlemesi ve büküntülü hale gelmesi olarak tanımlanır. En sık etkilenen damarlar; intrakranial vertebral ve baziler arterlerdir. Vertebrobaziler arter dolikoektazisi genellikle asemptomatiktir. Semptomatik olgularda, serebral iskemi, kanama ya da kitle etkisine bağlı bası bulguları görülür. Literatürde beşinci kraniyel sinir basısına bağlı olarak gelişen trigeminal nevralji ile ilgili olgu sunumları mevcut ise de, bildiğimiz kadarıyla, vertebrobaziler arter dolikoektazisine ikincil gelişen hemikrani veya sürekli bir yüz ağrısı daha önce rapor edilmemiştir. Burada, sağ tarafta sürekli yarım başağrısı şikayeti ile başvuran vertebrobaziler arter dolikoektazili 42 yaşında bir erkek hasta ve onun yeğeni olan, sağda sürekli fasiyel ağrı ile başvuran 19 yaşında bir kadın hasta sunuldu

Vertebrobasilar artery dolichoectesia and pain; coincidence or etiology?

Dolichoectesia is described as elongation, widening, and tortuosity of an artery. Most commonly involved vessels are the intracranial vertebral and basilar arteries. Vertebrobasilar artery dolichoectesia is usually asymptomatic. Cerebral ischemia, hemorrhage, or compression findings due to mass effect can be seen in symptomatic patients. Although there are case reports of trigeminal neuralgia due to fifth cranial nerve compression in the literature, to the best of our knowledge, neither hemicranial nor continuous facial pain secondary to vertebrobasilar artery dolichoectesia has been reported previously. Presently described is case of a 42-year-old male with vertebrobasilar dolichoectesia who had complaint of continuous right-sided hemicranial pain, and his 19-year-old niece, who presented with continuous right-sided facial pain

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Lou M, Caplan LR. Vertebrobasilar dilatative arteriopathy (dolichoectasia). Ann N Y Acad Sci 2010;1184:121–33.
Pico F, Labreuche J, Cohen A, Touboul PJ, Amarenco P; GENIC investigators. Intracranial arterial dolichoectasia is associated with enlarged descending thoracic aorta. Neu- rology 2004;63(11):2016–21.
Titlic M, Tonkic A, Jukic I, Kolic K, Dolic K. Clinical manifes- tations of vertebrobasilar dolichoectasia. Bratisl Lek Listy 2008;109(11):528–30.
Ma X, Sun X, Yao J, Ni S, Gong J, Wang J, et al. Clinical analy- sis of trigeminal neuralgia caused by vertebrobasilar dolic- hoectasia. Neurosurg Rev 2013;36(4):573–8.
Yu YL, Moseley IF, Pullicino P, McDonald WI. The clinical pic- ture of ectasia of the intracerebral arteries. J Neurol Neuro- surg Psychiatry 1982;45(1):29–36.
Dziewasa R, Freund M, Lüdemann P, Müller M, Ritter M, Droste DW, et al. Treatment options in vertebrobasilar dolichoectasia--case report and review of the literature. Eur Neurol 2003;49(4):245–7.
Ikeda K, Nakamura Y, Hirayama T, Sekine T, Nagata R, Kano O, et al. Cardiovascular risk and neuroradiological profiles in asymptomatic vertebrobasilar dolichoectasia. Cerebro- vasc Dis 2010;30(1):23–8.
Yoshimoto Y, Noguchi M, Tsutsumi Y. Encircling method of trigeminal nerve decompression for neuralgia caused by tortuous vertebrobasilar artery: technical note. Surg Neu- rol 1995;43(2):151–3.
Kraemer JL, Pereira Filho Ade A, David Gd, Faria Mde B. Ver- tebrobasilar dolichoectasia as a cause of trigeminal neural- gia: the role of microvascular decompression. Case report. Arq Neuropsiquiatr 2006;64(1):128–31.
Noma N, Kobayashi A, Kamo H, Imamura Y. Trigeminal ne- uralgia due to vertebrobasilar dolichoectasia: three case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108(3):50–5.
Ünlü N. Imaging Findings of Vertebrobasilar Dolichoecta- sia As A Cause Of Trigeminal Neuralgia. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2011;64(3):133–5.
Resta M, Gentile MA, Di Cuonzo F, Vinjau E, Brindicci D, Ca- rella A. Clinical-angiographic correlations in 132 patients with megadolichovertebrobasilar anomaly. Neuroradio- logy 1984;26(3):213–6.
Piatt JH Jr, Wilkins RH. Treatment of tic douloureux and he- mifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neu- rosurgery 1984;14(4):462–71.
Bederson JB, Wilson CB. Evaluation of microvascular de- compression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg. 1989;71(3):359–67.
Klun B. Microvascular decompression and partial sen- sory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery 1992;30(1):49–52.
Hamlyn PJ. Neurovascular relationships in the posterior cranial fossa, with special reference to trigeminal neural- gia. 1. Review of the literature and development of a new method of vascular injection-filling in cadaveric controls. Clin Anat 1997;10(6):371–9.
Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trige- minal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospecti- ve study in a series of 579 patients. Acta Neurochir (Wien) 2002;144(1):1–13.
Civelek E, Cansever T, Imer M, Hepgül K, Barlas O. Trigemi- nal neuralgia and treatment options. Agri 2005;17(3):19– 26.
Staikov IN, Mattle HP. Vertebrobasilar dolichoectasia and exertional headache. J Neurol Neurosurg Psychiatry 1994;57(12):1544.
Huang L, Yu CY, Wang BN, Zhang HM, Li LY, Wang Y. Ver- tebrobasilar dolichoectasia causing a presentation re- sembling basilar-type migraine. Clin Neurol Neurosurg 2013;115(6):784–6.
Kaplan Y, Kamışlı Ö, Altınayar S. Cluster-like headache as- sociated with vertebrobasilar dolichoectasia. Türk Beyin Damar Hastalıkları Dergisi 2014;20(3):112–5.
Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cepha- lalgia 2007;27(3):193–210.
Ramirez-Lassepas M, Espinosa CE, Cicero JJ, Johnston KL, Cipolle RJ, Barber DL. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol 1997;54(12):1506–9.
American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of pati- ents presenting to the emergency department with acute headache. Ann Emerg Med 2002;39(1):108–22.
Ramchandren S, Cross BJ, Liebeskind DS. Emergent hea- daches during pregnancy: correlation between neurologic examination and neuroimaging. AJNR Am J Neuroradiol 2007;28(6):1085–7.
Hainer BL, Matheson EM. Approach to acute headache in adults. Am Fam Physician 2013;87(10):682–7.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33(9):629–808.
Kwon HM, Lee YS. Dolichoectasia of the intracranial arteri- es. Curr Treat Options Cardiovasc Med 2011;13(3):261–7.
Wolfe T, Ubogu EE, Fernandes-Filho JA, Zaidat OO. Predic- tors of clinical outcome and mortality in vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiog- raphy. J Stroke Cerebrovasc Dis 2008;17(6):388–93.