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”.
Signs of vertebro-basilar insufficiency have certain similarities with other pathological processes leading to impaired functional state of various regions of the brain.
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.
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.
Through the vertebral arteries, up to 30% of the total blood volume enters the brain tissue. Vertebrobasilar insufficiency, which occurred in adults and pediatric patients, is accompanied by neurological symptoms, which reflects acute ischemic brain regions. After the completion of the next ischemic attack (TIA), residual manifestations of the resulting pathological changes are possible.
Violation of blood flow in the vertebro-basilar pool leads to a deterioration in total cerebral circulation, the occurrence of foci of ischemic tissue damage. Degenerative processes occur in the cells of the nervous tissue, provoked by hypoxia (oxygen starvation). Veins account for 85% of the circulatory system of the brain, which indicates the decisive nature of venous blood flow.
Damage to the veins in the WBD leads to the development of venous discirculation – a violation of the outflow of blood from the posterior parts of the head. A patient with a large-scale lesion of the elements of the vascular system simultaneously shows signs of venous dysfunction and VBI, which makes it difficult to differentiate pathology and determine the leading symptoms.
Symptoms of the disease
Vertebral-basilar insufficiency is more often manifested by several syndromes and symptoms. It is not always possible to highlight the leading signs. Malfunctions of the circulatory system in the WBB area provoke impaired motor function and sensitivity, hemianopsia (blindness in half of the visual vision), cortical blindness – complete loss of vision caused by damage to the brain structures in the back of the head. Treatment is necessary if symptoms occur:
- Ataxia, abnormal gait. Disorder of motor function due to impaired coordination during muscle contraction.
- Dizziness, impaired consciousness.
- Violation of synchronism with eye movement.
- Nystagmus is a frequent involuntary movement of the pupils.
- Dysarthria is a disorder of the function of speech due to a violation of the innervation of elements of the speech apparatus.
- Horner’s syndrome. Symptoms are manifested mainly on the face on the side of damage to the brain tissue. The main manifestations: ptosis (drooping of the eyelid due to impaired innervation of muscles), miosis (a decrease in pupil diameter), a weak reaction of the pupil to light, unilateral hyperemia of the skin of the face.
- Auditory dysfunction.
Sometimes agnosia (a violation of auditory, visual, tactile perception while maintaining consciousness), aphasia (loss of speech function partially or completely), disorientation in time, place, situation are added to the listed symptoms. VBI can manifest itself as a lacunar stroke with the following symptoms: hemiparesis (unilateral partial paralysis), hemihypesthesia (unilateral loss of sensitivity), hematiaxia (motor dysfunction on one side of the body).
The chronic form of the disease manifests itself identically to discirculatory encephalopathy with vestibulo-atactic syndrome. It is manifested by dizziness, flickering of extraneous (“flies”, spots) objects in front of the eyes, abnormal gait, impaired motor coordination and nausea. Dizziness is a characteristic sign of a pathological condition.
In vertebro-basilar insufficiency, paroxysmal and permanent symptoms are distinguished. In the first case, the symptoms appear during the attack and disappear after its completion, in the second – it remains between the attacks. Venous dysfunction in the carotid and vertebro-basilar pools is manifested by tinnitus. The patient has symptoms: headache, impaired motor and sensitivity, numbness of the limbs.
In the world of diagnostic practice, this ailment is included in the systematized International Classification of Diseases of the 10th revision and is called the “Vertebro-Basilar Arterial System Syndrome”. According to this official document approved by the World Health Organization, VBI is classified as a vascular disease associated with the nervous system.
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.
So that the acquired vertebro-basilar syndrome does not spoil the quality of life, the general recommendation for each person is to follow the regime of physical activity and use a special workout. Gymnastics for the prevention of VBI disease is performed smoothly, without stress. Classes are good to do in the morning after sleep, slowly warming up. Periodically take a course of relaxing massage and physiotherapy.
The most dangerous poses for gymnastics of patients with vertebro-basilar syndrome are the head, thrown back, the supine position (and it is impossible to sleep with this disease) and the circular rotation of the head with large amplitude. Effective exercises to reduce the manifestations of the disease are a warm-up with tilting and stretching the head. Each exercise should be repeated 10 times, then move on to the next. Here is the complex:
- bending your head forward, reach with your chin to your chest, after a few seconds return to its original position;
- tilt your head to the right and left, reaching for the shoulder;
- slowly turn your head in a circle, first in one direction, then in the other direction;
- stretch your head slowly forward, then return to its original position;
- pull the crown up, fix the position of the head for a few seconds, relax.
After that, use the complex for warming up the whole body, also repeating the exercises 10 times:
- turn the body left and right, reaching for the direction of rotation;
- standing straight, raise your hands, joining hands, and briefly lock in this position;
- stand on one leg for as long as possible, change your leg.
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.
Due to dysfunction of the vertebrobasilar arterial system, which supplies blood to the posterior parts of the head – the cerebellum, medulla oblongata, part of the thalamus, hypothalamus, posterior parts of the temporal and occipital lobes, the syndrome develops. One of the main causes is stenosis (persistent narrowing) of extracranial arteries (external, located on the external side of the skull) – subclavian, vertebral. Other causes of development:
- Thrombosis. The formation of blood clots clogging the vascular lumen.
- Atherosclerotic lesions of the vascular walls.
- Musculoskeletal dysplasia causing vascular deformities – aneurysms, stenosis.
- Compression of the vertebral arteries associated with diseases such as osteochondrosis, herniated disc, spondylosis, osteophytes (bone growths) in the spine.
- Muscle spasm in the neck.
- Dislocation of the vertebrae.
- The abnormal shape and location of arteries and veins (stratification of the arteries, aplasia – developmental defects, malformation – improper connection of the elements of the circulatory system among themselves), which lie in the basilar basin.
- Inflammatory processes (Takayasu disease, vasculitis, arthritis).
Other causes: myelopathy (violation of the conductivity of the structures of the spinal cord), injuries in the head and neck, instability of the vertebrae. Arterial hypertension, diabetes mellitus and excess weight are provoking factors. Statistics show that cerebral infarction caused by vertebrobasilar insufficiency syndrome in 43% of patients developed due to obstruction of the lumen of the main arteries, 20% due to cerebral embolism (blood clot in the circulatory system of the brain), and 19% due to cardiogenic embolism ( blood clot in the circulatory system of the atrium).
In 18% of patients, disorders occurred due to blockage of small vessels. One of the characteristic signs of vertebrobasilar syndrome – hemianopsia (blindness in half of the visual vision), developed in 96% of cases, as a result of occlusion (blockage) of the posterior artery of the brain. Vertebro-basilar disease in 10% of cases is accompanied by cerebral hemorrhage of a local type.