medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-295medsovet-10291Research ArticleПрактикаPracticeБоль в шее у пациентов с недифференцированной дисплазией соединительной ткани: сложности диагностикиNeck pain in patients with undifferentiated connective tissue dysplasia: Diagnostic challengesХайбуллинаД. Х.KhaibullinaD. Kh.

Хайбуллина Дина Хамитовна, к.м.н., доцент кафедры неврологии

420012, Казань, ул. Бутлерова, д. 36

Dina Kh. Khaibullina, Cand. Sci. (Med.), Associate Professor of the Department of Neurology

36, Butlerov St., Kazan, 420012

dina.khaibullina@mail.ruМаксимовЮ. Н.MaksimovY. N.

Максимов Юрий Николаевич, к.м.н., доцент кафедры неврологии

420012, Казань, ул. Бутлерова, д. 36

Yuri N. Maksimov, Cand. Sci. (Med.), Associate Professor of the Department of Neurology

36, Butlerov St., Kazan, 420012

yuri_maximov@mail.ruБилаловаК. Р.BilalovaK. R.

Билалова Камилла Робертовна, врач лучевой диагностики

420101, Казань, ул. Хусаина Мавлютова, д. 2

Kamilla R. Bilalova, Radiologist

2, Khusain Mavlyutov St., Kazan, 420101

kamillabilalova1993@yandex.ruКазанская государственная медицинская академия – филиал Российской медицинской академии непрерывного профессионального образованияРоссияKazan State Medical Academy – a branch of the Russian Medical Academy of Continuing Professional EducationRussian FederationБАРСМЕДРоссияBARSMED LLCRussian Federation20262807202600Online First10291Copyright © Хайбуллина Д.Х., Максимов Ю.Н., Билалова К.Р., 20262026Хайбуллина Д.Х., Максимов Ю.Н., Билалова К.Р.Khaibullina D.K., Maksimov Y.N., Bilalova K.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10291

Статья посвящена дифференциальной диагностике резистентной к терапии боли в шее. Традиционно цервикалгия рассматривается как неспецифическая скелетно-мышечная боль, успешно купируемая стандартной схемой (НПВП, миорелаксанты) в течение 2–4 нед. Однако в представленных 2 клинических случаях пациентов среднего возраста (45 и 48 лет) с подострым течением интенсивной боли длительностью 1–2 мес. стандартная терапия оказалась неэффективной, что потребовало пересмотра диагностической концепции. Описание представляет интерес, поскольку демонстрирует редкую причину вторичной цервикалгии: вертебробазилярную долихоэктазию, имитирующую неспецифическую скелетно-мышечную боль. Ключевыми «красными флагами» для углубленного обследования явились торпидность к лечению, постоянный характер боли, диссоциация между выраженностью болевого синдрома и локальным мышечным напряжением, а также фенотипические признаки дисплазии соединительной ткани (положительные критерии Бейтона). Проведение МР-ангиографии позволило верифицировать компрессию продолговатого мозга и моста извитой долихоэктатической левой позвоночной артерией. В результате диагноз был пересмотрен с неспецифической на вторичную боль вследствие нейроваскулярного конфликта и рекомендована консультация нейрохируга. Таким образом, при затяжной, некупируемой стандартной терапией боли в шее, ассоциированной с признаками дисплазии соединительной ткани, необходимо исключать сосудистые аномалии с целью своевременной коррекции тактики ведения данной категории пациентов.

This article discusses the differential diagnosis of treatment-resistant neck pain. Traditionally, cervicalgia is considered a nonspecific musculoskeletal pain successfully treated with standard treatment (NSAIDs, muscle relaxants) for 2–4 weeks. However, in the two presented clinical cases of middle-aged patients (45 and 48 years old) with subacute, intense pain lasting 1–2 months, standard therapy proved ineffective, necessitating a revision of the diagnostic framework. This description is of interest because it demonstrates a rare cause of secondary cervicalgia–vertebrobasilar dolichoectasia–simulating nonspecific musculoskeletal pain. Key “red flags” for further investigation included: reluctance to treatment, persistent pain, dissociation between pain severity and local muscle tension, and phenotypic features of connective tissue dysplasia (positive Beighton criteria). MR angiography verified compression of the medulla oblongata and pons by a tortuous, dolichoectatic left vertebral artery. As a result, the diagnosis was revised from nonspecific to secondary pain due to neurovascular conflict, and the patient was referred to a neurosurgeon. Therefore, in cases of prolonged neck pain associated with connective tissue dysplasia that is refractory to standard therapy, vascular anomalies must be excluded to promptly adjust the management strategy for this patient population.

боль в шеецервикалгияпозвоночная артериядолихоэктазиядисплазия соединительной тканисиндром гипермобильности суставовneck paincervicalgiavertebral arterydolichoectasiaconnective tissue dysplasiajoint hypermobility syndromeРабота выполнена за счет гранта №5/2025-ПД-КГМА от 22.12.2025 г., предоставленного Академией наук Республики Татарстан образовательным организациям высшего образования, научным и иным организациям на поддержку планов развития кадрового потенциала в части стимулирования их научных и научно-педагогических работников к защите докторских диссертаций и выполнению научно-исследовательских работThe authors would like to express their gratitude to all participants of the Cystic Fibrosis Patient Registry of the Russian Federation (CFPR-RF). The study was conducted in association with the All-Russian Patient Union as part of the Observational Assessment Program on the Current Cystic Fibrosis Treatment Landscape in Real-Life Clinical Practice within the project Institute of Accredited Public Cystic Fibrosis ExpertReferencesGuzman J, Hurwitz EL, Carroll LJ, Haldeman S, Côté P, Carragee EJ et al. A new conceptual model of neck pain: linking onset, course, and care: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4 Suppl):S14–23. https://doi.org/10.1097/brs.0b013e3181643efb.Guzman J, Hurwitz EL, Carroll LJ, Haldeman S, Côté P, Carragee EJ et al. A new conceptual model of neck pain: linking onset, course, and care: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4 Suppl):S14–23. https://doi.org/10.1097/brs.0b013e3181643efb.Carroll LJ, Holm LW, Hogg-Johnson S, Côté P, Cassidy JD, Haldeman S et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4 Suppl):S83–92. https://doi.org/10.1097/BRS.0b013e3181643eb8.Carroll LJ, Holm LW, Hogg-Johnson S, Côté P, Cassidy JD, Haldeman S et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4 Suppl):S83–92. https://doi.org/10.1097/BRS.0b013e3181643eb8.Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary. Spine. 2008;17(1 Suppl.):S5–7. https://doi.org/10.1097/brs.0b013e3181643f40.Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary. Spine. 2008;17(1 Suppl.):S5–7. https://doi.org/10.1097/brs.0b013e3181643f40.Садоха КА, Головко АМ. Боль в спине: эпидемиология, клинические проявления, классификация. Лечебное дело. 2016;6(52):53–56. Режим доступа: https://lech-delo.by/wp-content/uploads/arxiv/ld/lech_delo_6_(52)_2016.pdf.Sadokha KA, Golovko AM. Back pain: epidemiology, clinical manifestations and classification. Lechebnoe Delo. 2016;6(52):53–56. (In Russ.) Available at: https://lech-delo.by/wp-content/uploads/arxiv/ld/lech_delo_6_(52)_2016.pdfМухаметзянова АХ, Парфенов ВА. Исайкин АИ. Оптимизация ведения пациентов с неспецифической болью в шее. Российский журнал боли. 2024;22(1):40–46. https://doi.org/10.17116/pain20242201140.Mukhametzyanova AKh, Parfenov VA, Isaikin AI. Management of patients with nonspecific neck pain. Russian Journal of Pain. 2024;22(1):40–46. (In Russ.) https://doi.org/10.17116/pain20242201140.Табеева ГР. Боль в шее: клинический анализ причин и приоритетов терапии. Неврология, нейропсихиатрия, психосоматика. 2019;11(2S):69–75. https://doi.org/10.14412/2074-2711-2019-2S-69-75.Tabeeva GR. Neck pain: a clinical analysis of causes and therapy priorities. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):69–75. (In Russ.) https://doi.org/10.14412/2074-2711-2019-2S-69-75.Насонов ЕЛ, Яхно НН, Каратеев АЕ, Алексеева ЛИ, Баринов АН, Барулин АЕ и др. Общие принципы лечения скелетно-мышечной боли: междисциплинарный консенсус. Научно-практическая ревматология. 2016;54(3):247–265. Режим доступа: https://rsp.mediar-press.net/rsp/article/view/2206.Nasonov EL, Yakhno NN, Karateev AE, Alekseeva LI, Barinov AN, Barulin AE et al. General principles of treatment for musculoskeletal pain: interdisciplinary consensus. Rheumatology Science and Practice. 2016;54(3):247–265. (In Russ.) Available at: https://rsp.mediar-press.net/rsp/article/view/2206.Парфенов ВА, Яхно НН, Кукушкин МЛ, Давыдов ОС, Чурюканов МВ, Головачева ВА и др. Неспецифическая боль в шее (цервикалгия). Рекомендации Российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика. 2023;15(5):4–12. https://doi.org/10.14412/2074-27112023-5-4-12.Parfenov VA, Yakhno NN, Kukushkin ML, Davydov OS, Churyukanov MV, Golovacheva VA et al. Non-specific neck pain (cervicalgia). Guidelines of the Russian Society for the Study of Pain (RSSP). Neurology, Neuropsychiatry, Psychosomatics. 2023;15(5):4–12. (In Russ.) https://doi.org/10.14412/2074-2711-2023-5-4-12.Акатова ЕВ, Анастасьева ВГ, Аникин ВВ, Арсентьев ВГ, Арутюнов ГП, Баранов АА и др. Российское научное медицинское общество терапевтов (РНМОТ). Дисплазии соединительной ткани [Клинические рекомендации Российского научно-медицинского общества терапевтов]. Терапия. 2018;6(24):10–58. https://doi.org/10.18565/therapy.2018.6.10-58.Akatova EV, Anastasʹeva VG, Anikin VV, Arsentʹev VG, Arutyunov GP, Baranov AA et al. Russian Scientific Medical Society of Therapists (RSMST). Connective tissue dysplasia [Clinical guidelines of the Russian Scientific Medical Society of Therapists].. Therapy. 2018;6(24):10–58. (In Russ.) https://doi.org/10.18565/therapy.2018.6.10-58.Del Brutto VJ, Ortiz JG, Biller J. Intracranial Arterial Dolichoectasia. Front Neurol. 2017;8:344. https://doi.org/10.3389/fneur.2017.00344.Del Brutto VJ, Ortiz JG, Biller J. Intracranial Arterial Dolichoectasia. Front Neurol. 2017;8:344. https://doi.org/10.3389/fneur.2017.00344.Samim M, Goldstein A, Schindler J, Johnson MH. Multimodality Imaging of Vertebrobasilar Dolichoectasia: Clinical Presentations and Imaging Spectrum. Radiographics. 2016;36(4):1129–1146. https://doi.org/10.1148/rg.2016150032.Samim M, Goldstein A, Schindler J, Johnson MH. Multimodality Imaging of Vertebrobasilar Dolichoectasia: Clinical Presentations and Imaging Spectrum. Radiographics. 2016;36(4):1129–1146. https://doi.org/10.1148/rg.2016150032.Del Brutto VJ, Gutierrez J, Goryawala MZ, Sacco RL, Rundek T, Romano JG. Prevalence and Clinical Correlates of Intracranial Dolichoectasia in Individuals With Ischemic Stroke. Stroke. 2021;52(7):2311–2318. https://doi.org/10.1161/STROKEAHA.120.032225.Del Brutto VJ, Gutierrez J, Goryawala MZ, Sacco RL, Rundek T, Romano JG. Prevalence and Clinical Correlates of Intracranial Dolichoectasia in Individuals With Ischemic Stroke. Stroke. 2021;52(7):2311–2318. https://doi.org/10.1161/STROKEAHA.120.032225.Nakajima M, Pearce LA, Ohara N, Field TS, Bazan C, Anderson DC et al. Vertebrobasilar ectasia in patients with lacunar stroke: the secondary prevention of small subcortical strokes trial. J Stroke Cerebrovasc Dis. 2015;24(5):1052–1058. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.12.039.Nakajima M, Pearce LA, Ohara N, Field TS, Bazan C, Anderson DC et al. Vertebrobasilar ectasia in patients with lacunar stroke: the secondary prevention of small subcortical strokes trial. J Stroke Cerebrovasc Dis. 2015;24(5):1052–1058. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.12.039.Park JM, Koo JS, Kim BK, Kwon O, Lee JJ, Kang K et al. Vertebrobasilar dolichoectasia as a risk factor for cerebral microbleeds. Eur J Neurol. 2013;20(5):824–830. https://doi.org/10.1111/ene.12075.Park JM, Koo JS, Kim BK, Kwon O, Lee JJ, Kang K et al. Vertebrobasilar dolichoectasia as a risk factor for cerebral microbleeds. Eur J Neurol. 2013;20(5):824–830. https://doi.org/10.1111/ene.12075.Zhang X, Jing J, Zhao X, Liu L, Meng X, Wang A et al. Prognosis of dolichoectasia in non-cardioembolic transient ischemic attack and minor stroke. Neurol Res. 2018;40(6):452–458. https://doi.org/10.1080/01616412.2018.1451016.Zhang X, Jing J, Zhao X, Liu L, Meng X, Wang A et al. Prognosis of dolichoectasia in non-cardioembolic transient ischemic attack and minor stroke. Neurol Res. 2018;40(6):452–458. https://doi.org/10.1080/01616412.2018.1451016.Nakamura Y, Hirayama T, Ikeda K. Clinicoradiologic features of vertebrobasilar dolichoectasia in stroke patients. J Stroke Cerebrovasc Dis. 2012;21(1):5–10. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.04.003.Nakamura Y, Hirayama T, Ikeda K. Clinicoradiologic features of vertebrobasilar dolichoectasia in stroke patients. J Stroke Cerebrovasc Dis. 2012;21(1):5–10. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.04.003.Kwon HM, Kim JH, Lim JS, Park JH, Lee SH, Lee YS. Basilar artery dolichoectasia is associated with paramedian pontine infarction. Cerebrovasc Dis. 2009;27(2):114–118. https://doi.org/10.1159/000177917.Kwon HM, Kim JH, Lim JS, Park JH, Lee SH, Lee YS. Basilar artery dolichoectasia is associated with paramedian pontine infarction. Cerebrovasc Dis. 2009;27(2):114–118. https://doi.org/10.1159/000177917.Ikeda K, Nakamura Y, Hirayama T, Sekine T, Nagata R, Kano O et al. Cardiovascular risk and neuroradiological profiles in asymptomatic vertebrobasilar dolichoectasia. Cerebrovasc Dis. 2010;30(1):23–28. https://doi.org/10.1159/000313440.Ikeda K, Nakamura Y, Hirayama T, Sekine T, Nagata R, Kano O et al. Cardiovascular risk and neuroradiological profiles in asymptomatic vertebrobasilar dolichoectasia. Cerebrovasc Dis. 2010;30(1):23–28. https://doi.org/10.1159/000313440.Wolfe T, Ubogu EE, Fernandes-Filho JA, Zaidat OO. Predictors of clinical outcome and mortality in vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography. J Stroke Cerebrovasc Dis. 2008;17(6):388–393. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.06.006.Wolfe T, Ubogu EE, Fernandes-Filho JA, Zaidat OO. Predictors of clinical outcome and mortality in vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography. J Stroke Cerebrovasc Dis. 2008;17(6):388–393. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.06.006.Najafi MR, Toghianifar N, Abdar Esfahani M, Najafi MA, Mollakouchakian MJ. Dolichoectasia in vertebrobasilar arteries presented as transient ischemic attacks: A case report. ARYA Atheroscler. 2016;12(1):55–58. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4834182/.Najafi MR, Toghianifar N, Abdar Esfahani M, Najafi MA, Mollakouchakian MJ. Dolichoectasia in vertebrobasilar arteries presented as transient ischemic attacks: A case report. ARYA Atheroscler. 2016;12(1):55–58. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4834182/.Gutierrez J, Menshawy K, Gonzalez M, Goldman J, Elkind MS, Marshall R, Morgello S. Brain large artery inflammation associated with HIV and large artery remodeling. AIDS. 2016;30(3):415–423. https://doi.org/10.1097/QAD.0000000000000927.Gutierrez J, Menshawy K, Gonzalez M, Goldman J, Elkind MS, Marshall R, Morgello S. Brain large artery inflammation associated with HIV and large artery remodeling. AIDS. 2016;30(3):415–423. https://doi.org/10.1097/QAD.0000000000000927.Lodder J, Vles JS, Broekman JM. Megadolicho anomaly of the basilar artery caused by syphilis (a case report). Clin Neurol Neurosurg. 1982;84(4):255–259. https://doi.org/10.1016/0303-8467(82)90027-0.Lodder J, Vles JS, Broekman JM. Megadolicho anomaly of the basilar artery caused by syphilis (a case report). Clin Neurol Neurosurg. 1982;84(4):255–259. https://doi.org/10.1016/0303-8467(82)90027-0.Dalton CM, Jäger HR, Losseff NA, Greenwood RJ. Varicella zoster virus and intracranial dolichoectasia in a late adult cancer survivor. BMJ Case Rep. 2009;2009:bcr2007120725. https://doi.org/10.1136/bcr.2007.120725.Dalton CM, Jäger HR, Losseff NA, Greenwood RJ. Varicella zoster virus and intracranial dolichoectasia in a late adult cancer survivor. BMJ Case Rep. 2009;2009:bcr2007120725. https://doi.org/10.1136/bcr.2007.120725.Tipping B, de Villiers L, Candy S, Wainwright H. Stroke caused by human immunodeficiency virus-associated intracranial large-vessel aneurysmal vasculopathy. Arch Neurol. 2006;63(11):16402. https://doi.org/10.1001/archneur.63.11.1640.Tipping B, de Villiers L, Candy S, Wainwright H. Stroke caused by human immunodeficiency virus-associated intracranial large-vessel aneurysmal vasculopathy. Arch Neurol. 2006;63(11):16402. https://doi.org/10.1001/archneur.63.11.1640.Toyoshima Y, Emura I, Umeda Y, Fujita N, Kakita A, Takahashi H. Vertebral basilar system dolichoectasia with marked infiltration of IgG4-containingplasma cells: a manifestation of IgG4related disease? Neuropathology. 2012;32(1):100–104. doi: https://doi.org/10.1111/j.1440-1789.2011.01227.x.Toyoshima Y, Emura I, Umeda Y, Fujita N, Kakita A, Takahashi H. Vertebral basilar system dolichoectasia with marked infiltration of IgG4-containingplasma cells: a manifestation of IgG4related disease? Neuropathology. 2012;32(1):100–104. doi: https://doi.org/10.1111/j.1440-1789.2011.01227.x.Manara R, Carlier RY, Righetto S, Citton V, Locatelli G, Colas F et al. Basilar Artery Changes in Fabry Disease. AJNR Am J Neuroradiol. 2017;38(3):531–536. https://doi.org/10.3174/ajnr.A5069.Manara R, Carlier RY, Righetto S, Citton V, Locatelli G, Colas F et al. Basilar Artery Changes in Fabry Disease. AJNR Am J Neuroradiol. 2017;38(3):531–536. https://doi.org/10.3174/ajnr.A5069.Montagnese F, Granata F, Musumeci O, Rodolico C, Mondello S, Barca E, Cucinotta M, Ciranni A, Longo M, Toscano A. Intracranial arterial abnormalities in patients with late onset Pompe disease (LOPD). J Inherit Metab Dis. 2016;39(3):391–398. https://doi.org/10.1007/s10545-015-9913-x.Montagnese F, Granata F, Musumeci O, Rodolico C, Mondello S, Barca E, Cucinotta M, Ciranni A, Longo M, Toscano A. Intracranial arterial abnormalities in patients with late onset Pompe disease (LOPD). J Inherit Metab Dis. 2016;39(3):391–398. https://doi.org/10.1007/s10545-015-9913-x.Giannantoni NM, Broccolini A, Frisullo G, Pilato F, Profice P, Morosetti R et al. Neurofibromatosis type 1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke. J Neuroimaging. 2015;25(3):505–506. https://doi.org/10.1111/jon.12160.Giannantoni NM, Broccolini A, Frisullo G, Pilato F, Profice P, Morosetti R et al. Neurofibromatosis type 1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke. J Neuroimaging. 2015;25(3):505–506. https://doi.org/10.1111/jon.12160.Silverman IE, Berman DM, Dike GL, Sung GY, Litt B, Wityk RJ. Vertebrobasilar dolichoectasia associated with Marfan syndrome. J Stroke Cerebrovasc Dis. 2000;9(4):196–198. https://doi.org/10.1053/jscd.2000.7224.Silverman IE, Berman DM, Dike GL, Sung GY, Litt B, Wityk RJ. Vertebrobasilar dolichoectasia associated with Marfan syndrome. J Stroke Cerebrovasc Dis. 2000;9(4):196–198. https://doi.org/10.1053/jscd.2000.7224.Акимова АВ, Гончарова ДА, Дроздова АВ, Бураков МЮ, Миронов ВА, Андреев АН. Оценка симптомов, признаков дисплазии соединительной ткани и морфоанатомических особенностей поражений церебральных сосудов у пациентов с интракраниальными аневризмами. Вестник Уральской медицинской академической науки. 2018;5(4):513–520. https://doi.org/10.22138/2500-0918-2018-15-4-513-520.Akimova AV, Goncharova DA, Drozdova AV, Burakov MYu, Mironov VA, Andreev AN. Assessment of symptoms, signs of connective tissue dysplasia and morphoanatomical features of cerebral vascular lesions in patients with intracranial aneurysms. Vestnik Ural’skoi Meditsinskoi Akademicheskoi Nauki. 2018;15(4):513–520. (In Russ.) https://doi.org/10.22138/2500-0918-2018-15-4-513-520.Хайбуллина ДХ, Есин РГ. Неврологические аспекты дисплазии соединительной ткани. Журнал неврологии и психиатрии им. С.С. Корсакова. 2023;123(7):7–11. https://doi.org/10.17116/jnevro20231230717.Khaibullina DKh, Esin RG. Neurological aspects of connective tissue dysplasia. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2023;123(7):7–11. (In Russ.) https://doi.org/10.17116/jnevro20231230717.Nakatomi H, Segawa H, Kurata A, Shiokawa Y, Nagata K, Kamiyama H et al. Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke. 2000;31(4):896–900. https://doi.org/10.1161/01.str.31.4.896.Nakatomi H, Segawa H, Kurata A, Shiokawa Y, Nagata K, Kamiyama H et al. Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke. 2000;31(4):896–900. https://doi.org/10.1161/01.str.31.4.896.Pico F, Labreuche J, Amarenco P. Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia. Lancet Neurol. 2015;14(8):833–845. https://doi.org/10.1016/S1474-4422(15)00089-7.Pico F, Labreuche J, Amarenco P. Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia. Lancet Neurol. 2015;14(8):833–845. https://doi.org/10.1016/S1474-4422(15)00089-7.Zhang DP, Peng YF, Ma QK, Zhao M, Zhang HL, Yin S. Why does my patient’s basilar artery continue to grow? A four-year case study of a patient with symptoms of vertebrobasilar dolichoectasia. BMC Neurol. 2018;18(1):45. https://doi.org/10.1186/s12883-018-1045-0.Zhang DP, Peng YF, Ma QK, Zhao M, Zhang HL, Yin S. Why does my patient’s basilar artery continue to grow? A four-year case study of a patient with symptoms of vertebrobasilar dolichoectasia. BMC Neurol. 2018;18(1):45. https://doi.org/10.1186/s12883-018-1045-0.Jiang H, Zou D, Shao C, Wu N. Fully endoscopic microvascular decompression for painful tic convulsif secondary to vertebrobasilar dolichoectasia. Am J Transl Res. 2025;17(5):3824–3829. https://doi.org/10.62347/URCV2139.Jiang H, Zou D, Shao C, Wu N. Fully endoscopic microvascular decompression for painful tic convulsif secondary to vertebrobasilar dolichoectasia. Am J Transl Res. 2025;17(5):3824–3829. https://doi.org/10.62347/URCV2139.Rezai Jahromi B, Niemelä M. “Dolichoectatic Vertebrobasilar Artery Aneurysms”. Neurosurg Clin N Am. 2022;33(4):419–429. https://doi.org/10.1016/j.nec.2022.06.003.Rezai Jahromi B, Niemelä M. “Dolichoectatic Vertebrobasilar Artery Aneurysms”. Neurosurg Clin N Am. 2022;33(4):419–429. https://doi.org/10.1016/j.nec.2022.06.003.Sabet C, Aggarwal A. Abnormalities of the Vertebrobasilar Arterial System Leading to Sleep Disorders. J Stroke Cerebrovasc Dis. 2022;31(5):106383. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106383.Sabet C, Aggarwal A. Abnormalities of the Vertebrobasilar Arterial System Leading to Sleep Disorders. J Stroke Cerebrovasc Dis. 2022;31(5):106383. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106383.Aggarwal A, Kalra G, Caplan LR. Vertebrobasilar dolichoectasia and other arterial abnormalities leading to abducens nerve palsy. J Stroke Cerebrovasc Dis. 2023;32(5):107051. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107051.Aggarwal A, Kalra G, Caplan LR. Vertebrobasilar dolichoectasia and other arterial abnormalities leading to abducens nerve palsy. J Stroke Cerebrovasc Dis. 2023;32(5):107051. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107051.Ohhashi G, Irie K, Tani S, Ogawa T, Abe T, Hata Y. [Isolated abducens nerve palsy caused by the compression of the basilar artery: a case report]. No To Shinkei. 2001;53(1):69–72. Available at: https://pubmed.ncbi.nlm.nih.gov/11211735/.Ohhashi G, Irie K, Tani S, Ogawa T, Abe T, Hata Y. [Isolated abducens nerve palsy caused by the compression of the basilar artery: a case report]. No To Shinkei. 2001;53(1):69–72. Available at: https://pubmed.ncbi.nlm.nih.gov/11211735/.Goldenberg-Cohen N, Miller NR. Noninvasive neuroimaging of basilar artery dolichoectasia in a patient with an isolated abducens nerve paresis. Am J Ophthalmol. 2004;137(2):365–367. https://doi.org/10.1016/S0002-9394(03)00898-5.Goldenberg-Cohen N, Miller NR. Noninvasive neuroimaging of basilar artery dolichoectasia in a patient with an isolated abducens nerve paresis. Am J Ophthalmol. 2004;137(2):365–367. https://doi.org/10.1016/S0002-9394(03)00898-5.Yuh SJ, Alkherayf F, Lesiuk H. Dolichoectasia of the vertebral basilar and internal carotid arteries: A case report and literature review. Surg Neurol Int. 2013;4:153. https://doi.org/10.4103/2152-7806.122397.Yuh SJ, Alkherayf F, Lesiuk H. Dolichoectasia of the vertebral basilar and internal carotid arteries: A case report and literature review. Surg Neurol Int. 2013;4:153. https://doi.org/10.4103/2152-7806.122397.Nimodia D, Parihar PH, Dudhe S, Patil R, Bhangale PN, Kotla R. Navigating the neurovascular maze of trigeminal neuralgia. Radiol Case Rep. 2024;20(3):1363–1367. https://doi.org/10.1016/j.radcr.2024.11.054.Nimodia D, Parihar PH, Dudhe S, Patil R, Bhangale PN, Kotla R. Navigating the neurovascular maze of trigeminal neuralgia. Radiol Case Rep. 2024;20(3):1363–1367. https://doi.org/10.1016/j.radcr.2024.11.054.Arrese I, Sarabia R. Microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia. Case report, literature review, and pooled case analysis. Neurocirugia. 2016;27(6):304–309. https://doi.org/10.1016/j.neucir.2016.05.003.Arrese I, Sarabia R. Microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia. Case report, literature review, and pooled case analysis. Neurocirugia. 2016;27(6):304–309. https://doi.org/10.1016/j.neucir.2016.05.003.Степанян МА, Кондрахов СВ, Назаренко АГ, Артёменкова ЕЮ, Колычева МВ. Тригеминальная невралгия при вертебробазилярной долихоэктазии, микроваскулярная декомпрессия корешка тройничного нерва: описание трех случаев и обзор литературы. Кремлевская медицина. Клинический вестник. 2021;1:110–115. https://doi.org/10.26269/bhjk-9962.Stepanyan MA, Kondrakhov SV, Nazarenko AG, Artyomenkova EYu, Kolycheva MV. Trigeminal neuralgia caused in vertebrobasilar dolichoectasia, trigeminal microvascular decompression: description of three case reports and literature review. Kremlin Medicine Journal. Clinical Bulletin. 2021;1:110–115. https://doi.org/10.26269/bhjk-9962.Bissell JN, Edelbach B, Gospodarev V, De Los Reyes KM, Pillai P. Ectatic vertebral artery associated medullary compression treated with microvascular decompression: a case report and review of literature. J Med Case Rep. 2024;18(1):485. https://doi.org/10.1186/s13256-024-04713-x.Bissell JN, Edelbach B, Gospodarev V, De Los Reyes KM, Pillai P. Ectatic vertebral artery associated medullary compression treated with microvascular decompression: a case report and review of literature. J Med Case Rep. 2024;18(1):485. https://doi.org/10.1186/s13256-024-04713-x.Najafi MR, Toghianifar N, Abdar Esfahani M, Najafi MA, Mollakouchakian MJ. Dolichoectasia in vertebrobasilar arteries presented as transient ischemic attacks: A case report. ARYA Atheroscler. 2016;12(1):55–58. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4834182/.Najafi MR, Toghianifar N, Abdar Esfahani M, Najafi MA, Mollakouchakian MJ. Dolichoectasia in vertebrobasilar arteries presented as transient ischemic attacks: A case report. ARYA Atheroscler. 2016;12(1):55–58. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4834182/.Umana GE, Alberio N, Graziano F, Fricia M, Tomasi SO, Corbino L et al. Vertebrobasilar Dolichoectasia, Hypoplastic Third Ventricle, and Related Biventricular Hydrocephalus: Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg. 2023;84(2):206–211. https://doi.org/10.1055/s-0041-1725049.Umana GE, Alberio N, Graziano F, Fricia M, Tomasi SO, Corbino L et al. Vertebrobasilar Dolichoectasia, Hypoplastic Third Ventricle, and Related Biventricular Hydrocephalus: Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg. 2023;84(2):206–211. https://doi.org/10.1055/s-0041-1725049.Peng YF, Zhang HL, Zhang DP, Zhao M, Zhang SL, Yin S. Perfusion by delayed time to peak in vertebrobasilar dolichoectasia patients with vertigo. Ann Clin Transl Neurol. 2018;5(12):1562–1573. https://doi.org/10.1002/acn3.665.Peng YF, Zhang HL, Zhang DP, Zhao M, Zhang SL, Yin S. Perfusion by delayed time to peak in vertebrobasilar dolichoectasia patients with vertigo. Ann Clin Transl Neurol. 2018;5(12):1562–1573. https://doi.org/10.1002/acn3.665.Li Q, Xie P, Yang WS, Yan B, Davis S, Caplan LR. Vertebral Artery Compression Syndrome. Front Neurol. 2019;10:1075. https://doi.org/10.3389/fneur.2019.01075.Li Q, Xie P, Yang WS, Yan B, Davis S, Caplan LR. Vertebral Artery Compression Syndrome. Front Neurol. 2019;10:1075. https://doi.org/10.3389/fneur.2019.01075.Sabet CJ. Non-Dolichoectatic Vertebral Artery Compression of the Medulla: A Comprehensive Literature Review. J Stroke Cerebrovasc Dis. 2021;30(6):105750. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105750.Sabet CJ. Non-Dolichoectatic Vertebral Artery Compression of the Medulla: A Comprehensive Literature Review. J Stroke Cerebrovasc Dis. 2021;30(6):105750. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105750.Kutty RK, Yamada Y, Takizawa K, Kato Y. Medullary Compression Due to Ectatic Vertebral Artery-Case Report and Review of Literature. J Stroke Cerebrovasc Dis. 2020;29(1):104460. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104460.Kutty RK, Yamada Y, Takizawa K, Kato Y. Medullary Compression Due to Ectatic Vertebral Artery-Case Report and Review of Literature. J Stroke Cerebrovasc Dis. 2020;29(1):104460. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104460.Altayyar AA, Brokinkel B, Schick U, Fistouris P. Innovative neurovascular decompression for chronic intractable hiccups secondary to vertebral artery dolichoectasia: a novel surgical technique. Illustrative case. J Neurosurg Case Lessons. 2025;9(19):CASE2552. https://doi.org/10.3171/CASE2552.Altayyar AA, Brokinkel B, Schick U, Fistouris P. Innovative neurovascular decompression for chronic intractable hiccups secondary to vertebral artery dolichoectasia: a novel surgical technique. Illustrative case. J Neurosurg Case Lessons. 2025;9(19):CASE2552. https://doi.org/10.3171/CASE2552.Лихачев СА, Сидорович ЭК, Миронов СА, Линник ОВ, Павловская ЮМ. Долихоэктазия основной артерии с компрессией моста и продолговатого мозга как причина персистирующей икоты. Неврология и нейрохирургия. Восточная Европа. 2023;13(1):144–147. https://doi.org/10.34883/PI.2023.13.1.042.Likhachev SA, Sidorovich EK, Mironov SA, Linnik OV, Pavlovskaya JM. Dolichoectasia of the Main Artery with Compression of the Bridge and Medulla Oblongata as a Cause of Persistent Hiccups. “Neurology and Neurosurgery. Eastern Europe”. 2023;13(1):144–147. https://doi.org/10.34883/PI.2023.13.1.042.Younus O, Hampton T, Silber E, Dervenoulas G. Progressive bulbar symptomatology due to vascular brainstem compression. BMJ Case Rep. 2021;14(3):e238323. https://doi.org/10.1136/bcr-2020-238323.Younus O, Hampton T, Silber E, Dervenoulas G. Progressive bulbar symptomatology due to vascular brainstem compression. BMJ Case Rep. 2021;14(3):e238323. https://doi.org/10.1136/bcr-2020-238323.Jochheim L, Firmansyah O, Kanaya K, Kuwabara H, Firmansyah HR, Maruyama T et al. Macrovascular decompression for medullary compression syndrome due to vertebral dolichoectatic arteries: A case report and literature review with 3D imaging support. Surg Neurol Int. 2026;17:20. https://doi.org/10.25259/SNI_1227_2025.Jochheim L, Firmansyah O, Kanaya K, Kuwabara H, Firmansyah HR, Maruyama T et al. Macrovascular decompression for medullary compression syndrome due to vertebral dolichoectatic arteries: A case report and literature review with 3D imaging support. Surg Neurol Int. 2026;17:20. https://doi.org/10.25259/SNI_1227_2025.Sam A, Sanjaykanth B, Ramakrishnan KK, Vikram MA, Mohanakrishnan A. Left Anterolateral Medullary Compression Due to Vertebral Artery Dolichoectasia: A Case Report and Review of Literature. Cureus. 2024;16(8):e67361. https://doi.org/10.7759/cureus.67361.Sam A, Sanjaykanth B, Ramakrishnan KK, Vikram MA, Mohanakrishnan A. Left Anterolateral Medullary Compression Due to Vertebral Artery Dolichoectasia: A Case Report and Review of Literature. Cureus. 2024;16(8):e67361. https://doi.org/10.7759/cureus.67361.Munich SA, Morcos JJ. «Macrovascular» decompression of dolichoectatic vertebral artery causing hemifacial spasm using goretex sling: 2-dimensional operative video. Operat Neurosurg. 2019;16(2):267–268. https://doi.org/10.1093/ons/opy111.Munich SA, Morcos JJ. «Macrovascular» decompression of dolichoectatic vertebral artery causing hemifacial spasm using goretex sling: 2-dimensional operative video. Operat Neurosurg. 2019;16(2):267–268. https://doi.org/10.1093/ons/opy111.Honey CM, Kaufmann AM. Trigeminal Neuralgia due to Vertebrobasilar Artery Compression. World Neurosurg. 2018;118:e155-e160. https://doi.org/10.1016/j.wneu.2018.06.145.Honey CM, Kaufmann AM. Trigeminal Neuralgia due to Vertebrobasilar Artery Compression. World Neurosurg. 2018;118:e155-e160. https://doi.org/10.1016/j.wneu.2018.06.145.Straube A, Büttner U, Brandt T. Recurrent attacks with skew deviation, torsional nystagmus, and contraction of the left frontalis muscle. Neurology. 1994;44(1):177–178. https://doi.org/10.1212/WNL.44.1.177.Straube A, Büttner U, Brandt T. Recurrent attacks with skew deviation, torsional nystagmus, and contraction of the left frontalis muscle. Neurology. 1994;44(1):177–178. https://doi.org/10.1212/WNL.44.1.177.Silva-Hernández L, Silva-Hernández M, Gutiérrez-Viedma A, Yus M, Cuadrado ML. Hemifacial spasm and vestibular paroxysmia: Co-presence of two neurovascular compression syndromes in a patient. Neurologia. 2019;34(2):131–133. https://doi.org/10.1016/j.nrleng.2018.09.002.Silva-Hernández L, Silva-Hernández M, Gutiérrez-Viedma A, Yus M, Cuadrado ML. Hemifacial spasm and vestibular paroxysmia: Co-presence of two neurovascular compression syndromes in a patient. Neurologia. 2019;34(2):131–133. https://doi.org/10.1016/j.nrleng.2018.09.002.Han J, Wang T, Xie Y, Cao D, Kang Z, Song X. Successive occurrence of vertebrobasilar dolichectasia induced trigeminal neuralgia, vestibular paroxysmia and hemifacial spasm: A case report. Medicine. 2018;97(25):e11192. https://doi.org/10.1097/MD.0000000000011192.Han J, Wang T, Xie Y, Cao D, Kang Z, Song X. Successive occurrence of vertebrobasilar dolichectasia induced trigeminal neuralgia, vestibular paroxysmia and hemifacial spasm: A case report. Medicine. 2018;97(25):e11192. https://doi.org/10.1097/MD.0000000000011192.Goldschagg N, Brem C, Strupp M. Case report: Bitter vertigo. Front Neurol. 2022;13:1028597. https://doi.org/10.3389/fneur.2022.1028597.Goldschagg N, Brem C, Strupp M. Case report: Bitter vertigo. Front Neurol. 2022;13:1028597. https://doi.org/10.3389/fneur.2022.1028597.Чернуха ТН, Марьенко ИП, Лихачев СА, Клебан АВ, Миронов СА. Долихоэктазия базилярной артерии, обусловленная кистозной медиальной дегенерацией, как причина нейроваскулярного конфликта с поражением тройничного, лицевого и вестибулокохлеарного нервов. Журнал неврологии и психиатрии им. С.С. Корсакова. 2023;123(12):82–87. https://doi.org/10.17116/jnevro202312312282.Charnukha TN, Maryenko IP, Likhachev SA, Kleban HV, Mironov SA. Dolichoectasia of the basilar artery caused by cystic medial degeneration, as a cause of neurovascular conflict with damage to the trigeminal, facial and vestibulocochlear nerves. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2023;123(12):82–87. (In Russ.) https://doi.org/10.17116/jnevro202312312282.Alam S, Rahman A, Biswas M, Ahmed N, Bozkurt I, Khinikadze M, Chaurasia B. An enlightening experience of dealing a pediatric Vertebrobasilar Dolichoectasia (VBDE). Childs Nerv Syst. 2026;42(1):234. https://doi.org/10.1007/s00381-026-07303-y.Alam S, Rahman A, Biswas M, Ahmed N, Bozkurt I, Khinikadze M, Chaurasia B. An enlightening experience of dealing a pediatric Vertebrobasilar Dolichoectasia (VBDE). Childs Nerv Syst. 2026;42(1):234. https://doi.org/10.1007/s00381-026-07303-y.Li J, Cheng N, Liu T, Rong Q. Vertebrobasilar dolichoectasia compresses midbrain, worsens Parkinson symptoms, and evokes Holmes tremor: A case report. Medicine. 2026;105(3):e47275. https://doi.org/10.1097/MD.0000000000047275.Li J, Cheng N, Liu T, Rong Q. Vertebrobasilar dolichoectasia compresses midbrain, worsens Parkinson symptoms, and evokes Holmes tremor: A case report. Medicine. 2026;105(3):e47275. https://doi.org/10.1097/MD.0000000000047275.Li Q, Xie P, Yang WS, Yan B, Davis S, Caplan LR. Vertebral Artery Compression Syndrome. Front Neurol. 2019;10:1075. https://doi.org/10.3389/fneur.2019.01075.Li Q, Xie P, Yang WS, Yan B, Davis S, Caplan LR. Vertebral Artery Compression Syndrome. Front Neurol. 2019;10:1075. https://doi.org/10.3389/fneur.2019.01075.Ghannam M, Berns M, Salari A, Moore L, Brown K. Symptomatic Vascular Compression of Brainstem May Be Managed Conservatively. Life. 2022;12(8):1179. https://doi.org/10.3390/life12081179.Ghannam M, Berns M, Salari A, Moore L, Brown K. Symptomatic Vascular Compression of Brainstem May Be Managed Conservatively. Life. 2022;12(8):1179. https://doi.org/10.3390/life12081179.

The authors declare that there are no conflicts of interest present.