Vertebrobasilar insufficiency

A disorder caused by decrease of blood flow in the vertebral or basilar arteries due to atherosclerosis or compression placed on the external wall of the arteries. Symptoms may include loss of vision, dizziness, or nausea. Also called VBI, vertebrobasilar circulatory disorders, or posterior circulation ischemia.

Definisi

transient ischemia of the brain stem and cerebellum due to stenosis of the vertebral or basilar artery

Baloh 1996,Vertigo merupakan gejala yg paling sering muncul pada insufisiensi vertebrobasilar,namun tidak selalu jelas organ mana yang mengalami iskemi.

Vertebrobasilar insufisiensi

vertigo or dizziness difficulty walking properly double or Blurred Vision difficulty talking or controlling the movements of

the mouth numbness around the mouth weakness or numbness on one or both sides of the

body. Some patients have "drop attacks," experiencing

weakness of both legs and collapse without losing consciousness

At times, these symptoms may worsen with a changes in posture, when extending or bending the neck, or when moving or lifting the arms.

Simptom

Vertigo with associated Neurological signs Diplopia Ataxia Drop attacks Dysarthria Paralysis/weakness/Numbness Headache Risk factors (HTN, Diabetes, Coronary

Disease)

Vertebrobasilar Insufficiency /TIA’s

Radiographs of the cervical spine of 32 elderly patients clinically diagnosed as having vertebrobasilar insufficiency secondary to cervical spondylosis were compared with 32 age- and sex-matched controls. The mean age was 77.6 years. There was no significant difference in the severity of the radiological changes between the two groups as judged by the narrowing of disc space and marginal osteophyte formation.

It is concluded that there is no place for routine examination of the cervical spine in patients thought to have vertebrobasilar insufficiency secondary to cervical spondylosis

ARE CERVICAL SPINE RADIOGRAPHS OF VALUE IN ELDERLY PATIENTS WITH VERTEBROBASILAR INSUFFICIENCY?

PATIENTS AND METHODS: Forty-six patients with vertebrobasilar ischemia and 40 control subjects were examined during head rotation using transcranial Doppler ultrasonography. RESULTS: In the control group, no difference in blood flow velocity through the BA was found between the neutral and rotated positions. Based on these data, a blood flow reduction in the BA of more than 20% was considered to be significantly abnormal (p < 0.01). In three of 46 patients no signal was detectable in the BA using TCD. The reduction in blood flow velocity through the BA during head rotation was strongly dependent on the condition of the VA; none of 23 patients without atherosclerotic lesions or hypoplasia of the VA developed a significant reduction in blood flow through the BA. Two of 11 patients with unilateral VA lesions had significantly reduced blood flow in the BA (27% and 31%), although both were asymptomatic. Five of nine patients with bilateral VA lesions showed a significant reduction in blood flow through the BA (mean = 52%, minimum = 30%), and four of these developed clinical symptoms such as vertigo or diplopia during the rotation maneuver. CONCLUSION: These data suggest that patients with uni- or bilateral lesions of the VA are at risk for developing clinically relevant reductions in blood flow through the BA during head rotation. Because not all patients with VA lesions developed reduced blood flow velocity, we conclude that individual vascular mechanisms must play an important compensatory role.

Basilar artery blood flow during head rotation in vertebrobasilar ischemia

Syndrome of Vertebrobasilar Artery Occlusion:

- Binocular visual loss - Diplopia - Vertigo - unilateral or bilateral weakness, numbness or

clumsiness : - can alternate between right and left side in

different attacks - can be crossed, with some symptom right and

others on left - Ataxia - Dysarthria - Dysphagia - Hearing loss - Drop attack - Sign of cerebellum disfunction

(Adams Jr. et al., 2002)