What happens when there is insufficiency
Two vertebral arteries ascend along the cervical spine and merge into the basilar artery in the cranial cavity. Narrowing of these vessels by plaque, thrombus, or wall dissection reduces blood flow in the brainstem, cerebellum, and occipital lobes. If blood flow is restored quickly, the symptoms go away - this is a transient ischemic attack. If not, a stroke develops. As a rule, there is no chronic “lack of blood flow” when turning the head due to osteochondrosis: collateral vessels compensate for such changes.
- Transient ischemic attack in the vertebrobasilar region
- Ischemic stroke of the brainstem and cerebellum
- Vertebral or basilar artery stenosis
- Vertebral artery dissection
- Subclavian steal syndrome - rare
Causes and risk factors
The most common cause in older people is atherosclerosis with the formation of plaques at the mouth of the vertebral artery or in the basilar artery. In young people, an important cause is dissection of the wall of the vertebral artery after sudden movements of the neck, trauma, and sometimes after manual manipulation. Blood clots can be brought from the heart during atrial fibrillation. Risk factors are the same as for other cerebrovascular diseases.
- Atherosclerosis
- Arterial hypertension
- Diabetes mellitus
- Smoking
- Atrial fibrillation
- Neck injury, sharp manipulation of the cervical spine
Symptoms
Damage to the posterior parts of the brain is characterized by a combination of several symptoms that occur suddenly. Dizziness alone without other symptoms is rarely vascular. Rotational vertigo when turning the head or getting out of bed, lasting up to a minute, is most often caused by benign positional vertigo, a disease of the inner ear that is well treated with special maneuvers. The doctor must distinguish between these conditions.
- Dizziness with unsteadiness
- Double vision, loss of visual fields
- Slurred speech, difficulty swallowing
- Impaired coordination of movements
- Numbness of the face, arms and legs
- Sudden falls without loss of consciousness
Diagnostics
In case of sudden symptoms, an examination is carried out urgently in a hospital. MRI of the brain in diffusion-weighted mode reveals fresh foci of ischemia, MR or CT angiography shows narrowing and dissection of the arteries. Duplex scanning of the vertebral arteries in the neck complements the picture, but sees the intracranial parts worse. ECG and 24-hour monitoring look for atrial fibrillation, tests look for high cholesterol and sugar. X-rays of the cervical spine and rheoencephalography are not informative for diagnosing VBI.
- Neurological examination
- MRI of the brain with diffusion mode
- MR or CT angiography of the vessels of the head and neck
- Duplex scanning of the brachiocephalic arteries
- ECG, Holter monitoring
- Lipid spectrum, glucose, HbA1c
Treatment and prevention of stroke
Treatment is aimed at preventing stroke. After a transient attack, the doctor prescribes antiplatelet agents, and for atrial fibrillation, anticoagulants. Statins lower cholesterol and stabilize plaques. It is necessary to control blood pressure and sugar, stop smoking. For severe vertebral artery stenosis with recurrent symptoms despite treatment, stenting is considered in selected cases. Arterial dissection is treated with antithrombotic drugs under the supervision of a neurologist. Cervical collars, chiropractic care, and vascular IVs do not prevent stroke.
- Urgent examination after any episode
- Antiplatelet agents or anticoagulants as prescribed
- Statins
- Blood pressure and sugar control
- Quitting smoking
- Refusal of sharp manipulations on the neck