Fariba Zarei, - Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
Farzaneh Ghazi Sherbaf - Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran. Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, ۶۰۰ N Wo
Meisam Hoseinyazdi, - Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran

Introduction: Cerebral arterial dolicoectasia is a rare vascular disorder, mostly diagnosed incidentally. However, some patients present with deleterious vascular events or various clinical pictures of mass effect resulting from pressure by the large and tortuous artery. There is still no consensus guideline for the treatment or follow up of these patients, especially regarding those who are asymptomatic. This angiopathy mostly affects the vertebrobasilar symptom and the carotid involvement is less addressed in the literature. Here, we present an incidental finding of dolicoectasia of the supra clinoid portion of the right internal carotid in a 60-year-old woman with chronic hypertension, diagnosed by MR angiography. Case Presentation: A 60-year-old woman with a history of arterial hypertension and hypercholesterolemia presented to the emergency department with headache for one day. Her blood pressure at admission measured 178/92 mmHg. The headache was generalized with moderate severity and was relieved with controlling the blood pressure. She had no previous history of cerebrovascular or coronary accidents. Neurologic examination was normal. Emergency Brain computed tomography (CT) scan without contrast revealed mural calcification of the supra clinoid portion of the right ICA with a large diameter and high density (Fig.1). There was an intraluminal hypodensity suspicious to thrombosis. Therefore, the patient was further evaluated by magnetic resonance arteriography. Thrombosis was ruled out and the incidental evidence of dolichoectasia at the same segment was detected (Fig.2). There were no other vascular or any neural pathologic features detected on brain images. Conclusion: The course of dolichoectasia, specifically in the anterior circulation, has been presented in few case reports or small case series. Therefore, more presentations are needed for better understanding and management of this rare angiopathy, which might result in unfavorable outcomes with high morbidity and mortality.

dolicoectasia, internal carotid, vasculopathy, MR angiography, case report