Vertebrobasilar insufficiency: symptoms,treatment

Update: November 2018

Vertebrobasilar insufficiency (VBI) syndrome implies
complex of symptoms characteristic of insufficient blood supply
certain parts of the brain fed by vertebrates and
main artery. In this case, the reasons for its development can be
are different.

The syndrome occurs often, has, as a rule, chronic
forms, acute seizures occur according to the type of ischemic attacks and
strokes. Как проявляется вертебробазилярная недостаточность,
ее симптомы и treatment, далее в статье.

What is the vertebrobasilar system

Головной мозг кровоснабжается of двух основных артерий –
internal carotid (carotid) and vertebral (vertebral).
Большая часть мозга (полушария) питаются of бассейна каротидной
arteries.

The vertebral artery accounts for about 30% of the cerebral
blood flow. It departs from the subclavian artery, passes in the canal,
formed by the openings of the transverse processes of the cervical vertebrae.
Penetrating into the cranial space, both vertebral arteries (right and
left) merge with each other and form a basilar (main)
artery. It is located on the lower surface of the oblong
brain, branches depart from it, feeding the cerebellum, the bridge, the midbrain,
optic tubercle, occipital lobes, hypothalamus and thalamus, cervical
the spine.

Accordingly, in violation of the flow of the vertebral or
the main arteries will suffer those functions that are responsible for
these parts of the brain: coordination, hearing, vision, swallowing,
sensitivity and movement in the upper limbs, memory,
Attention.

The reasons

  • Atherosclerosis with the development of subclavian or vertebral stenosis
    arteries.
  • Тромбоз позвоночной или основной arteries.
  • Osteochondrosis of the cervical spine (artery can
    to be compressed by osteophytes, herniated disc, sliding vertebra
    (spondylolisthesis).
  • Anomalies of vascular development – hypoplasia, pathological
    ofвитость, нетипичное ответвление.
  • Arteritis – inflammatory vascular disease (for example,
    Takayasu syndrome).

    Остеохондроз шейного отдела позвоночника одна of причин ВБН

  • Anomalies of vertebral development (for example, Kimmerly anomaly –
    the presence of an additional bone arch in the first cervical vertebra,
    additional neck ribs).
  • Injuries to the neck, leading to compression of blood vessels.
  • Spasm of arteries with arterial hypertension.
  • Reflex spasm of arteries with pain syndrome.
  • Hypertrophy or pathological spasm of the muscles of the neck. Syndrome
    scalene muscle: hypertrophied muscle fibers squeeze
    vertebral artery in the place of its discharge from the subclavian.
  • Syndrome обкрадывания (при стенозе подключичной артерии верхняя
    конечность «забирает» часть кровотока of позвоночной).
  • Fibrous muscular dysplasia. This pathology is manifested in
    молодом возрасте, характерofуется сегментарным сужением просвета
    arteries (on angiography, the vessel looks like a string of beads).
  • Artery lesions on the background of diabetes.

Risk factors for developing VBN

If a person has a congenital vascular anomaly,
or osteochondrosis of the cervical spine, this does not mean
that he is sure to develop circulatory failure in
specified pool. But with some risk factors
the likelihood of this is increasing.

  • Dyslipidemia – elevated blood cholesterol and impaired
    lipoprotein ratios.
  • Untreated arterial hypertension.
  • Increased blood viscosity.
  • Diabetes.
  • Alcohol abuse.
  • Smoking.
  • Heart rhythm disorders.
  • Increased risk of valvular heart disease
    thrombosis.

Provoke the onset of ischemic attack in
vertebrobasilar can:

  • Гипертонический крof.
  • Sharp decrease in arterial pressure.
  • Long uncomfortable position of the head.
  • A sharp twist or re-bend of the neck.
  • Stress.
  • Non-professional massage or manual therapy.
  • Head or neck injury.

    Doubling and blurred eyes, tinnitus, dizziness alone
    of симптомов ВБН

Symptoms

  • Bouts of vertigo, often accompanied by nausea,
    vomiting.
  • Disbalance (uncertainty, unsteadiness when walking).
  • Сильные боли, локалofованные в затылочной области.
  • Double eyes.
  • Blurred vision, a feeling of pulsation before the eyes,
    intolerance bright colors.
  • Decreased hearing.
  • Noise in ears.
  • Sharp limitation of visual fields down to short-term
    blindness.
  • Distraction, disorientation.
  • Fainting Drop attacks (falls without loss of consciousness).
  • Swallowing disorder.
  • Neuritis of the facial nerve (asymmetry of the face).
  • Not very pronounced, but motor may appear
    disturbances – a feeling of weakness in the limbs, insecurity in
    movements.
  • Violation of sensitivity, and more often bilateral, for example,
    can numb the whole face.

For the severity of symptoms, the following options are possible.
VBN:

  1. Acute onset, lasting from a few minutes to a few
    часов — транзиторные ишемические атаки (ТИА).
    Характерofуется очень быстрым развитием симптомов и их
    disappearance within a day. About 70% of all TIAs develop in
    vertebrobasilar basin. In 30% can lead to ischemic
    a stroke.
  2. If a symptoms persist for more than a day, but regress after 3
    недели – говорят о малом ишемическом
    stroke
  3. Cases where the symptoms of neurological deficit remain more
    3-х недель, определяют как завершенный ишемический инсульт
    in the WB-pool.
  4. Хроническое течение ВБН, проявляется
    repetitive attacks, but some attacks remain between attacks
    symptoms of vertebrobasilar insufficiency. For example, human
    may cause persistent headaches in the occipital region,
    incoordination (ataxia), dizziness, tinnitus,
    hearing loss, impaired memory. 

Vertebrobasilar insufficiency in children

Previously it was believed that this pathology is found only in people
older and middle age. However, today it is established that
VBN often occurs in children. Most affected by this ailment
children 3-4 years, 7-10 and 12-14 years.

The most common causes are congenital anomalies of the vertebral and
основной arteries. Symptoms ВБН у детей:

  • Constricting headaches during prolonged sitting,
    excitement.
  • Fatigue, impaired attention and decreased
    of memory.
  • Drowsiness.
  • Fainting, dizziness, with nausea.

Such children tend to suffer from poor posture,
scoliosis.Vertebrobasilar insufficiency: symptoms, treatment

Diagnosis of VBN

  • VBN can be suspected by complaints and symptoms, especially if they are
    have developed keenly.
  • On examination, a neurologist can identify:
    • Нистагм – непроofвольные колебательные движения глазных яблок
      when looking to the side.
    • Cranial nerve lesions (facial asymmetry, strabismus).
    • Check coordinating samples, sensitivity.
    • Compare the power of the limbs.
    • Identify pathological reflexes.
  • Ultrasound examination of vessels (USDG) – duplex
    сканирование позвоночных и внутримозговых arteries. Allows
    obtain data on their permeability, degree of stenosis, presence
    атеросклеротических бляшек, скорости blood flow. USDG can be
    carried out with functional tests (turns and bends
    heads).
  • Radiography of the cervical spine will help identify
    causes of spondylogenous VBN – osteochondrosis, spondylarthrosis,
    spondylolisthesis, anomalies of bone structures. Also held with
    functional tests.
  • MRI of the cervical spine.
  • MRI – angiography is less accessible, but gives clear information about
    condition of the main arteries of the head.
  • Radiocontrast angiography is performed while planning
    оперативных вмешательств или тромболofиса (лекарственного
    thrombus dissolution).

Tactics in detecting VBN

Пациенты с острой ВБН с подозрением на
транзиторную ишемическую атаку должны быть госпиталofированы в
vascular center in the shortest possible time.

The tactics of first aid is the same as in the case of suspicion
stroke:

  • The patient must be laid, slightly lifting his head (approximately
    at 30 degrees).
  • Minimize head movement.
  • Blood pressure cannot be drastically reduced (if you suspect
    stroke to reduce blood pressure should be gradually and only with numbers above 200 mm
    RS)
  • Give 10 tablets (1 g) to chew or crush into powder
    glycine.

Пациенты с хронической вертебробазилярной
недостаточностью
обследуются и наблюдаются у невролога.
Symptoms, характерные для этой патологии, могут наблюдаться при
many diseases, so careful here is very important
differential diagnosis.

Treatment

  • During exacerbation of the disease it is necessary to ensure maximum
    rest with restricted head movements. If a есть нестабильность в
    neck section, can be used collar Shantz.
  • Neuroprotective therapy. Aims to reduce cerebral ischemia
    и активofацию цереброваскулярного резерва. Used drugs:

    • The solution of magnesium sulfate intravenously.
    • Glycine.
    • Mexidol.
    • Cytoflavin.
    • Церебролofин.
    • Cortexin.
    • Citicoline
    • Actovegin.
  • Vasodilator drugs.
    • Vinpocetine.
    • Циннарofин.
    • Pentoxifylline.
  • Nootropics – Piracetam, Fenotropil, Phenibut, Picamilon, etc.
  • Симптоматическое treatment.
    • Betagistin is used to relieve vertigo.
      Vertikhogel, Meklozin, Diazepam.
    • In case of nausea and vomiting, metoclopramide, Domperidone is prescribed.
  • Treatment вертебробазилярной недостаточности, направленное на
    elimination of the cause and provoking factors.

    • The use of drugs that reduce cholesterol in
      atherosclerosis.
    • Selection of antihypertensive drugs to eliminate drops
      pressure.
    • Treatment нарушений сердечного ритма.
    • According to indications – taking drugs for blood thinning and
      профилактики thrombosis.
    • Selection of adequate glucose-lowering therapy in sugar
      diabetes.
    • When spondylogenous VBN (associated with the pathology of the cervical
      spinal column) are also possible non-drug methods
      treatment: massage, manual therapy, acupuncture, magnetic and
      лазерное treatment, фонофорез и др.

Оперативное treatment

In what cases with VBN syndrome operations are performed?

Оперативное treatment даст явный эффект тогда, когда можно удалить
mechanical obstruction of the bloodstream. Such an obstacle can be
atherosclerotic plaque in the vessel lumen, osteophytes or
intervertebral hernia compressing vertebral artery
outside.

The main types of operations used in pathology
vertebrobasilar blood flow:

  • Endarterectomy – atherosclerotic plaque removal of
    lumen of the artery.
  • Microdiscectomy – removal of the intervertebral disc.
  • Nucleoplasty – removal of a bulging pulposal nucleus.
  • Osteophyte resection (bone overgrown on the vertebrae
    protrusions).
  • Vertebral artery angioplasty – the establishment of a special
    stent to expand its lumen.

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