Dolichoectasia Involving Both Anterior and Posterior Circulations: A Case Report and Literature Review

We report a case of a 79-year-old woman who presented with transient left upper limb weakness following recent cardiac surgery. Brain MRI revealed an acute infarction in the right caudate nucleus and multiple old microbleeds. Magnetic resonance angiography and contrast-enhanced CT demonstrated extensive fusiform dilatation of the supraclinoid internal carotid arteries, middle cerebral arteries, and posterior circulation, consistent with dolichoectasia involving both anterior and posterior circulations. The episode was diagnosed as a transient ischemic attack (TIA), and antithrombotic therapy was withheld due to coexisting chronic subdural hematomas and cerebral microbleeds. While posterior circulation dolichoectasia is relatively well documented, anterior involvement and combined anterior-posterior cases are rare. This case underscores the importance of considering dolichoectasia in the differential diagnosis of TIA, especially when neuroimaging reveals atypical vascular morphology. Recognition of this entity and further accumulation of case data are crucial to elucidate its underlying mechanisms and optimize treatment strategies.