Vertebrobasilar dolichoectasia presenting simultaneously with ischemic and hemorrhagic strokes

Background: Vertebrobasilar dolichoectasia (VBDE) can present with brainstem- compressive symptoms, cerebral ischemia, or hemorrhage. Herein we describe a unique patient with VBDE who presented with hemorrhage and cerebral ischemia simultaneously. Case: Patient is a 76-year-old man presenting with an acute, symptomatic left pontine ischemic stroke heralded by ataxic dysarthria and right ataxic-hemiparesis. MRI scan of the brain demonstrated acute cerebral ischemia in the left pons, a small right thalamic hemorrhage, and evidence of VBDE. Conclusion: The perforating vessels branching off of the pathologic VBDE may result in both ischemia and hemorrhage. This is the first known case, to our knowledge, in which hemorrhage and cerebral ischemia occurred simultaneously.