Vertebro-basilar insufficiency or vestibular syndrome

Vertebral arteries supply blood mainly to the posterior regions of the brain. The blood flow volume is 30% (70% of the blood enters the brain through the carotid arteries). They merge, form the main (basilar) artery, so the violation of blood flow in them is called vertebro-basilar insufficiency.

A decrease in the diameter of one of the blood vessels leads to a decrease in the speed and volume of blood flow, which results in insufficient intake of glucose and oxygen in the brain tissue. Neurocytes (cells of the nervous system) are very sensitive to energy starvation, therefore, against the background of a slight deterioration in blood supply, a pronounced violation of the functional state of the structures of the nervous system develops.

Depending on the causes and development mechanism, congenital and acquired VBI is distinguished. Causes of the congenital pathological process include:

  • Disorders at the genetic level, leading to malformations of the blood vessels (excessive tortuosity, leading to poor blood flow).
  • Fetal injuries leading to damage to arterial vessels of varying severity.
  • Severe pregnancy and childbirth – multiple pregnancy, premature birth.

Acquired VBI usually develops in adults. In this case, initially the arterial vessels are not changed. Violation of blood flow in them develops after exposure to the following causative factors:

  • The transferred injuries of the cervical spine, leading to its deformation and subsequent compression of the vertebral arteries in the corresponding bony channels formed by the openings of the transverse processes of the vertebrae.
  • Arterial sclerosis is a metabolic disorder in which cholesterol is deposited (a specific organic compound of the fat class) in the walls of arterial vessels with the formation of atherosclerotic plaques that reduce the diameter of the lumen of the vessel.
  • Hypertension is a prolonged increase in the level of systemic blood pressure, leading to severe spasm (narrowing) of some arterial vessels with a deterioration in blood flow in them.
  • The inflammatory process affecting the inner layer of the wall of the corresponding arteries – arteritis, angiitis, vasculitis. A decrease in the lumen of the artery usually occurs against the background of edema of inflamed soft tissues.
  • Osteochondrosis of the cervical spine, which often leads to mechanical compression of the vertebral artery.
  • Hypertrophy (increase in volume) of the scalene muscle, leading to mechanical compression of the subclavian artery.
  • Vertebral or subclavian artery thrombosis is an intravascular thrombus formation with subsequent blockage of a vessel with a smaller diameter. This is the main cause of cardiovascular complications, including severe vertebro-basilar insufficiency. Pathology is associated with a complete cessation of blood flow in a clogged vessel. Thrombosis can provoke atherosclerosis, increased blood pressure, impaired functional state of the hemostatic system (blood coagulation system), infectious processes, thrombophlebitis (inflammation of the venous vessels with the formation of blood clots in them).
  • Stratification of the inner layer of the wall of arterial vessels, leading to a subsequent decrease in the lumen of the vessel.
  • Diabetes mellitus is a metabolic disorder with a prolonged increase in sugar levels. This leads to damage to target organs, including arterial vessels. The result is a spasm with impaired blood flow.
  • Autoimmune pathology (Hughes-Stovin syndrome), characterized by “erroneous” production of antibodies to the body’s own tissues, including arterial blood vessels. As a result, specific chronic inflammation develops, leading to impaired blood flow in the affected arteries.

Since vertebro-basilar insufficiency is a polyetiological pathological process that develops as a result of the influence of a large number of reasons, knowledge of etiological factors will allow you to choose the optimal treatment, as well as conduct effective preventive measures.

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Symptoms of VBN

Depending on the origin, vertebro-basilar insufficiency may be accompanied by an acute or chronic course. In most cases, the symptoms appear gradually, “gradually.” Manifestations reflect violations of the functional state of the parts of the brain that are responsible for a variety of functions. The most common symptoms of a pathological condition include:

  • Headache, which is mainly localized in the back of the head and has a pulsating or pressing character.
  • Tinnitus, which has a different intensity or timbre (there are cases of complaints of tinnitus, reminiscent of the chirping of grasshoppers). The intensity of the noise depends on the severity of the blood flow disturbance in the brain tissues. Amid tinnitus, hearing usually worsens.
  • Memory impairment, distraction, it becomes difficult for a person to concentrate.
  • Imbalance, gait, which indicates a deterioration in the nutrition of the structures of the inner ear.
  • Fatigue, general weakness, which are more pronounced in the afternoon.
  • Visual impairment – the corresponding centers are localized in the occipital region of the brain. Violations include a decrease in visual acuity, the appearance of cattle (“flies”, “stars”, “flashes” in front of the eyes), narrowing or loss of visual fields.
  • Changes in the emotional background – a person becomes irritable, mood can change significantly during the day.
  • Permanent or periodic dizziness of varying severity, indicating a violation of the functional state of the center of equilibrium and the vestibular apparatus.
  • Vegetative manifestations, which include increased sweating, periodic “hot flashes” of heat or cold in the area of ​​the face, increased heart rate (tachycardia), increased levels of systemic blood pressure.
  • The appearance of hoarseness of voice, an unpleasant sensation of a “coma in the throat”.
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Signs of vertebro-basilar insufficiency have certain similarities with other pathological processes leading to impaired functional state of various regions of the brain.

Diagnostics

The appearance of clinical signs of vertebro-basilar insufficiency gives rise to a pathological condition. To reliably determine the nature, localization and severity of changes in the corresponding arterial vessels, an additional diagnostic examination is prescribed using the following techniques for visualizing internal structures:

  • Radiography is an affordable technique that can be carried out in almost any medical institution. It allows you to identify gross changes in the cervical spine, indicating the development of osteochondrosis. In this case, impairment of blood flow in the arteries of the vertebro-basilar basin is indirectly diagnosed.
  • Computed tomography is a modern x-ray technique in which layer-by-layer scanning of tissues is performed. It has a high resolution and makes it possible to visualize minimal changes in tissues and blood vessels, regardless of their density.
  • Magnetic resonance imaging is a layer-by-layer scanning of tissues; for visualization, the effect of resonance of nuclei in a strong magnetic field is used. Against the background of the study, radiation exposure does not affect the human body. In connection with the features of the technique (strong magnetic field), magnetic resonance imaging cannot be prescribed to people with metal implants.
  • Dopplerography of the vessels of the neck is an ultrasound study, with which it is possible to determine the direction, speed and volume of blood flow in the corresponding vessels.
  • Angiography is an X-ray technique by which an obstruction to the flow of blood in arterial vessels is visualized. Previously, a special contrast compound is injected into the blood, then a series of x-ray photographs is performed.

To assess the functional state of the human body, an additional examination is prescribed.

It includes a number of laboratory tests (clinical analysis of blood, urine, liver biochemical, kidney tests, blood sugar, hemogram), functional methods (electrocardiography, echocardiography), as well as instrumental (fluorography, ultrasound of the abdominal cavity, heart, thyroid gland) survey.

Based on the results of all the studies, the doctor has the opportunity to make a conclusion about the cause, nature and severity of the pathological condition. They are also the basis for admission to perform surgical intervention.

VBN treatment

Treatment of vertebro-basilar insufficiency is complex. It pursues several goals – elimination of the causative factor, restoration of blood flow in the arteries, as well as the functional state of the brain. For this, the attending physician prescribes 2 main areas of therapeutic measures:

  • Conservative treatment.
  • Surgical intervention.

The choice of the direction of therapeutic measures is carried out after the examination on the basis of the nature, localization and severity of changes in the arteries of the vertebro-basilar basin.

In most cases, conservative treatment of vertebro-basilar insufficiency is prescribed.

It includes general recommendations, which include a rational mode of work and rest, rejection of bad habits, a diet with a restriction of fatty fried foods, massage, special exercises of physiotherapy exercises. The basis of conservative therapy is the use of drugs of various pharmacological groups:

  • Nonsteroidal anti-inflammatory drugs (Ketanov, Nimesil, Diclofenac) – drugs are prescribed to reduce the severity of inflammation.
  • Drugs to lower blood cholesterol in atherosclerosis (Atorvastatin).
  • Antiplatelet agents (acetylsalicylic acid), which make it possible to prevent intravascular blood clots.
  • Neuroprotectors (Piracetam) – drugs that improve the metabolism of nerve cells in conditions of energy starvation.
  • Vascular enlargement agents (Niacin), which improve blood flow in the arteries of the brain.

clinical picture

Dizziness

It occurs during malfunctions of the blood supply to the vestibular apparatus and is one of the most frequent manifestations of VBI. Usually dizziness occurs suddenly and lasts from several minutes to hours. In severe cases, it is accompanied by nausea, vomiting, sweating, changes in heart rate and blood pressure. It can sometimes faint.

Headache

It is usually localized in the neck. May be pulsating or dull.

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Impaired vision

VBN is characterized by both long-term and short-term vision loss, flies or darkening before the eyes, loss of visual fields. Sometimes diplopia occurs, less often – various oculomotor disorders.

This condition is characterized by a sharp one-sided decrease in hearing or the appearance in the ears of noise of a different timbre.

Fainting

Occurs with a temporary violation of cerebral blood flow.

It manifests itself as a loss of interest in the environment, weakness, lethargy, increased fatigability, sudden mood swings, irritability, and tearfulness.
Vertebro-basilar insufficiency tends to progress rapidly. In the later stages of the disease, serious complications may develop: speech and swallowing disorders, drop attacks and ischemic strokes of varying severity.

The clinic (symptomatology) that occurs with ischemia of the vertebro-basilar basin can be very diverse. A common symptom – dizziness – is often accompanied by nausea, vomiting. Vertigo is a phenomenon that is an initial symptom in about half of all cases, with a violation of the vertebral circulation.

  • impaired vision;
  • diplopia;
  • blurred vision;
  • unilateral and bilateral homonymous hemianopsia;
  • dysarthria;
  • dysphagia;
  • paresthesia – mild paralysis, insensitivity in the face;
  • various combinations of weakness or lack of sensitivity in the legs.

Vertebro-basilar insufficiency, the symptoms of which often alternate, can only manifest vertigo, which can occur as an isolated sign. Long periods of relapse (more than 6 months) with dizziness without other accompaniments for VBI are not typical. Tinnitus and hearing loss are not common symptoms.

In approximately 40% of cases, attacks of vertebro-basilar insufficiency last more than 1 hour, although often the patients themselves indicate a duration of several minutes. About 90% of TIAs last less than 2 hours. The difference between the 2 states is that VBI, as a rule, has a shorter duration than the TIA of the carotid region. The severity of symptoms is very variable, from mild to severe. The frequency of attacks varies from single to multiple seizures throughout the day.

The condition of vertebro-basilar insufficiency is a combination of symptoms. According to one study group, 43% of patients had vertigo, 60% had ataxia, 39% had diplopia, 27% had dysarthria, 37% had blurred vision. Manifestations may be different depending on the defeat of the extra- or intracranial part. The defeat of the extracranial vertebral part, mainly dizziness, impaired vision, imbalance, involvement of the intracranial part is characterized only by vertigo. TIA, due to damage to the basilar artery, usually has 2 or more of the following symptoms:

  • dizziness;
  • slurred speech;
  • double vision;
  • dysphagia;
  • unilateral or bilateral weakness in the limbs.

With vertebro-basilar insufficiency, a sudden short-term loss of muscle tone (drop attacks) can occur; the patient, being conscious, suddenly falls (mainly to his knees). With a more severe lesion, loss of consciousness occurs – syncope.

When examining patients, it is important to correlate subjective symptoms with objective neurological signs of vertebro-basilar territory. Frequent and important objective manifestations include:

  • nystagmus;
  • oculomotor disturbances;
  • Horner’s syndrome (ptosis and meiosis, sometimes anhidrosis on the affected side);
  • numbness and motor impairment on the face and limbs;
  • speech disorders, coordination.

An examination of posture and gait is important. In patients, only one symptom is indicated as a subjective symptom, for example, vertigo, with an objective examination, other manifestations are determined, in particular, ataxia of the limbs or trunk. For localized lesions, variable (crossed) syndromes are typical when, on the affected side, ipsilaterally, there is a failure of the cranial nerve core, Horner’s syndrome or cerebellar syndrome, and hemiparesis or hemigipesthesia forms on the contralateral side. For vertebro-basilar insufficiency, any combination of weakness, paresthesia, numbness of the upper and lower extremities, face is characteristic.

Prevention

The following recommendations will help prevent the occurrence of vertebro-basilar insufficiency syndrome:

  • timely treatment of diseases of the spine;
  • balanced diet;
  • moderate physical activity;
  • quitting smoking and alcohol;
  • control of blood pressure;
  • elimination of stress factors.

Patients at risk should systematically check their blood cholesterol levels, conduct timely correction of neurotic disorders, and regularly take blood-thinning drugs.

Brain workers who spend most of the day bowing their heads need to do a little workout every hour. At lunchtime it is useful to take a walk, and after work to walk to the house.

A favorable prognosis of vertebro-basilar vascular insufficiency largely depends on the timeliness and adequacy of the treatment. In the absence of therapy, the formation of a chronic state with frequent ischemic attacks and the subsequent development of a stroke is possible. Therefore, you need to be patient and strictly follow all the doctor’s recommendations.

To prevent the development of the disease, doctors recommend getting rid of bad habits, normalizing body weight, and organizing the right diet. Useful dosed, regular physical activity, walks in the fresh air. People over 50 years of age need constant monitoring of blood pressure and blood glucose concentrations.

VBI is one of the types of cerebral blood flow disorders that develops as a result of damage to elements of the arterial system. Pathology identified in the early stages is treatable.

Pathogenesis

The pathogenesis of both TIA and VBI is essentially similar to the pathology of ischemic (lacunar, hemorrhagic) stroke. The causes of vertebro-basilar insufficiency are atherosclerosis of large vessels (31%), diseases of small vessels (16%), intra-arterial embolism (17%), cardiac embolism (27%) and various rare factors (9%).

The disease can affect not only adult women, men, but also representatives of the pediatric population. VBI in children can develop as a result of congenital pathologies of the vertebral or basilar artery. Often, causes include injuries to the spine of a child during sports training, gymnastics. A relatively common cause is a birth injury to the spine.

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The most common atherosclerotic vascular lesions located at the beginning of the vertebral arteries, intracranial part of the vertebral arteries, the proximal and middle part of the basilar artery, proximal part a. cerebri posterior. Smaller branches (for example, AICA, PICA) are more likely to be affected by the atherosclerotic process than large branches.

The involvement of perforating small arterioles (50-200 microns in diameter) is different from the process of atherosclerosis. The process is known as lipogialinosis, usually associated with arterial hypertension. Due to the anatomy of these small arterioles, the consequence of their occlusion is small single or multiple trigeminal infarction.

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With vertebro-basilar insufficiency, light exercises without sudden movements are most effective. Regular exercises help to remove muscle spasms, improve posture and strengthen the spine muscle corset.

Massotherapy

Massage helps to dilate blood vessels and improve blood circulation.

Physiotherapy

For the treatment of vertebro-basilar insufficiency, percutaneous electroneurostimulation, ultraphonophoresis, magnetotherapy, and laser therapy are used.

Reflexology

In the treatment of vertebro-basilar syndrome, it is used to eliminate pain and excitement of various nerve centers of the brain.

Kinesiotape

With VBI, it is effective as a means to eliminate muscle cramps and vascular injuries.

Surgical treatment is indicated only in extreme and severe cases of vertebro-basilar insufficiency. With the help of surgical intervention, circulatory failure associated with a decrease in the diameter of the vertebral artery as a result of stenosis, compression or spasm is eliminated. Typical operations for vertebro-basilar insufficiency are: microdisectomy, endarterectomy, laser reconstruction of intervertebral discs, vertebral artery angioplasty with stent placement.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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