Basilar artery dolichoectasia presenting as obstructive hydrocephalus mimicking normal pressure hydrocephalus

Vertebrobasilar dolichoectasia is a well-recognized vascular anomaly characterized by tortuosity, elongation, and dilatation of the vertebrobasilar arteries with associated hemodynamic changes. Hydrocephalus secondary to this condition is rare but may clinically mimic idiopathic normal pressure hydrocephalus (iNPH). We report the case of a 58-year-old man with poorly controlled hypertension who presented with progressive gait instability, cognitive impairment, and urinary incontinence over one month. Neuroimaging demonstrated ventriculomegaly with transependymal oedema and marked vertebrobasilar dolichoectasia, with the basilar artery compressing the floor of the third ventricle. Quantitative imaging supported a diagnosis of obstructive hydrocephalus rather than iNPH. This case highlights an important vascular cause of secondary hydrocephalus and emphasizes the need for careful radiological evaluation in patients presenting with the classical triad of normal pressure hydrocephalus.