An Autopsy Case of Brainstem Infarction Due to Thrombosis in Vertebrobasilar Dolichoectasia

Vertebrobasilar dolichoectasia (VBD) is a rare cerebrovascular disorder characterized by elongation, dilatation, and tortuosity of the vertebrobasilar arteries. It can lead to ischemic or hemorrhagic stroke, brainstem compression, hydrocephalus, or sudden death. We report the autopsy of a 53-year-old man who died suddenly with evidence of VBD-associated thrombosis. He had recently experienced orthopnea, palpitations, significant weight loss, and progressive decline in hearing and vision. Clinical evaluation performed the day before his death raised suspicion of heart failure. Autopsy revealed elongation and dilation of the vertebrobasilar artery, accompanied by atheromatous plaque rupture and intraluminal thrombosis. Thrombosis at this site was considered the cause of brainstem infarction, resulting in sudden death. The coronary arteries also showed luminal dilatation and severe atherosclerosis. These findings suggest that dolichoectasia may represent a systemic arteriopathy. This case highlights the importance of recognizing VBD as a potential cause of sudden death. Furthermore, because VBD can cause cerebral infarctions in multiple regions and present with diverse neurological symptoms, histopathological examination of various brain areas is essential in autopsy practice.