Why is blood flow disrupted?
The vertebral artery passes through narrow openings in the transverse processes of the cervical vertebrae, and then makes several bends at the base of the skull. Any narrowing of this channel - bone growths due to osteochondrosis, displacement of the vertebrae, spasm of the deep muscles of the neck - mechanically restricts blood flow or irritates the sympathetic plexus around the vessel. Separate causes are identified within the vessel itself: atherosclerotic plaque, tortuosity, congenital narrowing or wall dissection after injury. The body partially compensates for the deficiency through the second artery and the vascular ring at the base of the brain, so symptoms often appear only in certain positions of the head.
- Bone growths and arthrosis of the cervical joints
- Instability and displacement of the vertebrae
- Spasm of deep neck muscles
- Atherosclerotic plaque and vessel tortuosity
- Congenital hypoplasia of one artery
- Anomaly of the craniovertebral junction
- Arterial wall dissection after neck injury
Symptoms
The most common complaint is dizziness, which appears or intensifies when turning, bending, and especially throwing back the head, during prolonged work with the head raised, after sleeping on a high pillow. The typical type is a throbbing pain that begins in the back of the head and spreads forward to the temple and eye, often on one side. To this are added noise and ringing in the ears, a feeling of unsteadiness of the floor, darkening and flickering before the eyes. Occasionally, with a sharp turn of the head, a short-term attack of falling occurs without loss of consciousness.
- Dizziness and unsteadiness when moving the head
- Throbbing pain from the back of the head to the temple
- Noise, ringing and congestion in the ears
- Flashing of flies, darkening and fog before the eyes
- Nausea when changing position
- Decreased attention, fatigue, sleep disturbance
- Rarely - a sudden fall when turning the head sharply
Diagnostics
The neurologist checks stability, coordination, nystagmus and brain stem symptoms, palpating the neck muscles and exit points of the occipital nerves. The main vascular study is duplex scanning of the brachiocephalic arteries, in which the speed of blood flow, the diameter of the vessel and its changes when turning the head can be assessed. MRI of the cervical spine with examination of the neck vessels shows hernias, arthrosis, compression and course of the artery. X-ray with functional tests reveals instability. Pathology of the inner ear must be excluded.
- Examination by a neurologist with coordination tests
- Duplex scanning of the brachiocephalic arteries
- MRI of the cervical spine and neck vessels
- X-ray of the cervical spine with functional tests
- Transcranial Dopplerography
- Consultation with an otolaryngologist for severe dizziness
- Lipid spectrum and blood glucose for suspected atherosclerosis
Treatment
Treatment targets the cause, not just the symptom. With cervical origin, the basis is working with muscles and posture: physical therapy, gentle manual and physical therapy, proper organization of the workplace, a low pillow. Your doctor may prescribe medications that improve cerebral blood flow and reduce dizziness, as well as medications to relieve muscle spasms. With atherosclerosis, control of blood pressure, lipids and smoking cessation come to the fore. Surgical intervention is rarely considered - in case of severe narrowing or compression of the artery, confirmed by examination.
- Physical therapy for the neck and strengthening of the back muscles
- Correction of the workplace and sleeping pillows
- Gentle massage of the collar area and physiotherapy
- Drugs prescribed by a neurologist
- Control of blood pressure, cholesterol and glucose
- Refusal of sudden throwing back and rotation of the head
- Surgical treatment for confirmed arterial stenosis