What Is Vertebrobasilar Ischemia?

The disease is common in the elderly. Because the cerebellum and brain stem rely on the vertebral-basal artery for blood supply, symptoms such as dizziness often occur when the vertebral-basal artery is inadequately supplied with blood.

Basic Information

Visiting department

Neurology

Multiple groups

Middle-aged and elderly

Common locations

Vertebrobasilar artery

Common causes

Cervical spondylosis, cerebral atherosclerosis, hypotension, cerebral arteritis, large neck blood vessels distortion

Common symptoms

Dizziness, nausea and vomiting, blurred vision, diplopia, unilateral and bilateral ipsilateral visual field defects, poor language, numbness of the face and limbs, etc.

Causes of vertebrobasilar insufficiency

The vertebral arteries originate from the subclavian arteries on both sides, rise in the transverse process holes of the 6th to 1st cervical vertebrae, enter the skull through the foramen of the occipital bone, merge into the basilar artery at the lower edge of the pontine, and divide into the left and right brains after the midbrain artery. The vertebrobasilar artery has many branches in the skull, and its blood supply area includes the brain nerves in the brainstem, the ascending and descending conduction beams, the auditory vestibular organs, the temporal lobe, the occipital lobe, and the thalamus. When the blood supply is inadequate, complex clinical symptoms will appear, which will vary depending on the location, extent, and collateral circulation of the lesion. The etiology is mostly cervical spondylosis, cerebral atherosclerosis, hypotension, cerebral arteritis, large neck blood vessels distortion, heart disease, vascular malformation, hypercoagulable state, subclavian artery stealing syndrome and so on.

Clinical manifestations of vertebrobasilar insufficiency

Dizziness, nausea, vomiting, unstable walking, or blurred vision, diplopia, unilateral and bilateral ipsilateral visual field defects, or poor speech, fainting or falling, numbness of the face and limbs, and abnormal sensations.

Vertebro basilar artery insufficiency test

Cervical spine X-ray

Including the upright, lateral, oblique and hyperextension positions, determine whether the patient has abnormal changes such as cervical hyperplasia, narrow intervertebral space, and cervical disc herniation.

2. Transcranial Doppler Ultrasound (TCD)

According to its spectrum image, average blood flow velocity (vm), and pulsatility index, the vertebral artery and basal artery can be detected from the occipital window to determine the hemodynamics of the vertebrobasilar artery and its main branches. Narrowing or spasms provide evidence for the diagnosis of vertebrobasilar insufficiency.

3. Brainstem auditory evoked potential (BAEP)

It has a certain value for the diagnosis of vertebrobasilar insufficiency.

Diagnosis of vertebrobasilar insufficiency

Diagnosis can be made based on the cause, clinical manifestations, and laboratory tests.

Treatment of vertebrobasilar insufficiency

Acute attack treatment

In the acute episode, there are more severe vertigo, accompanied by nausea, vomiting, unstable standing and other symptoms. Symptoms such as dizziness should be treated as soon as possible. Generally, comprehensive measures should be taken, mainly by intramuscular injection or intravenous injection.

2. Improve cerebral ischemia and hypoxia and regulate cerebral metabolic function

In addition to the application of hemodilution therapy, cerebral vasodilators, calcium channel antagonists, ginkgo biloba preparations, anti-platelet aggregation drugs and other treatments, brain cell activators such as piracetam (nafukang), pyrithion ( Naoxinxin), -aminobutyric acid, hydroergotine preparations. Hyperbaric oxygen treatment is available, which has a certain effect on relieving insufficient blood supply to the vertebrobasilar artery. Studies have shown that external counterpulsation, helium-neon laser irradiation therapy and ultraviolet irradiation oxygenated autotransfusion therapy have certain effects.

3. Etiology treatment

To treat various causes of insufficient blood supply to the vertebral basilar artery, such as cerebral atherosclerosis, hypertension, hyperlipidemia, cervical spondylosis, heart disease, diabetes, etc. Corresponding treatment can achieve better results. Surgical interventional vascular intervention, vertebral artery reconstruction or angioplasty can be performed to improve their blood flow.

4. General treatment and functional exercise

Cerebral arteriosclerosis, hypertension, cervical spondylosis, etc. are important causes of insufficient blood supply to the vertebrobasilar artery, but so far, no specific treatment for these diseases has been available. Early diagnosis and early treatment can effectively improve the blood supply to the brain, promote the establishment of collateral circulation of the brain, correct risk factors such as blood lipids and blood glucose, reduce symptoms, inhibit the progress of the disease, and prevent complications. These are currently active treatment measures.