Dolichoectasia of basilar artery presenting as non-communicating hydrocephalus-A rare presentation

Vertebrobasilar dolichoectasia is characterised by vascular elongation, tortuosity and widening of the vertebral or basilar arteries, with highly varied presentations. Hydrocephalus can rarely occur as a result of compression of the aqueduct of Sylvius or of the 3rd ventricle by the dolichoectatic basilar artery. Here, we present a case of basilar artery dolichoectasia leading to compression of the floor of the third ventricle resulting in obstructive hydrocephalus. A 67-year-old woman, hypertensive on regular treatment presented with a history of giddiness, difficulty while walking, slowness of gait and disorientation of two days duration. Her evaluation for metabolic and infective etiology were non-contributory. Magnetic resonance imaging of the brain done showed triventricular hydrocephalus with periventricular seepage of cerebrospinal fluid. Magnetic resonance angiogram of the brain with contrast showed dolichoectatic basilar artery compressing the floor of the third ventricle resulting in reduced flow of CSF through the aqueduct. Ventriculoperitoneal shunt (VP shunt) was inserted, following which there was a clinical improvement.