Severe Hydrocephalus due to Obstructive Basilar Dolichoectasia of the Third Ventricle

Vertebro-basilar dolichoectasia (VBD) is a rare pathology of unknown aetiology. Its clinical presentation is wide and prognosis is generally poor with a high mortality rate. Cerebral magnetic resonance imaging is the gold standard for diagnosis. We report an unusual case of intracranial dolichoectasia. VBD was revealed during investigation of a patient with altered mental status. CT brain imaging demonstrated severe obstructive hydrocephalus secondary to compression of the third ventricle. Management is always challenging and depends on the location and the mode of presentation. Our patient died despite surgical management with placement of an external ventricular shunt. LEARNING POINTS: Vertebro-basilar dolichoectasia is a little known cause of altered mental status in elderly patients. An atypical presentation of vertebro-basilar dolichoectasia can mimic extensive cerebrovascular haemorrhage. The prognosis is poor despite prompt diagnosis and the surgical treatment of choice.