What is the vertebral-basilar insufficiency
Vertebrobasilar insufficiency, or syndrome of vertebrobasilar arterial system, is a reversible process the disorder in the functioning of the brain due to the deterioration of cerebral circulation. It is caused by weakening of the blood flow in the vertebral and basilar arteries.
The result of vascular insufficiency becomes malnutrition of brain cells, leading to functional disorders of the Central nervous system.
The main reasons
There are a number of factors contributing to the development of this disease:
- osteochondrosis of the cervical spine;
- injuries to the neck leading to compression of the vertebral artery;
- atherosclerosis and conduction disorder of the blood vascular;
- high blood pressure
- fibro-muscular dysplasia;
- hypoplasia of the vertebral arteries.
- inflammation of the blood vascular;
- hypertrophy scalene muscle, leading to compression of the vertebral artery;
- congenital malformations of the vascular bed;
- dissection (dissection) vertebrobasilar arteries: damage to the walls becomes a cause of leakage of blood between the tissues;
- thrombosis of the main or vertebral artery;
- diabetes, which affects small vascular of the brain;
- antiphospholipid syndrome (disease contributes to blood clot formation and lack of patency of the arteries;
- compression of the arteries (vertebral, or basilar) as a result of spondylosis, spondylolisthesis, vertebral hernias;
- predisposition to disease: can be expressed in the form of the pathological conditions leading to abnormalities of blood vascular or in the form of genetic predisposition.
The clinical picture
The signs of vertebrobasilar insufficiency can be divided into two groups:
Symptoms of a temporary nature have different duration (from several hours to days) and is manifested in the so-called transient ischemic attacks, which is a transient acute violation of cerebral circulation.
The main characteristics of this group:
- tightness in the neck;
- the constant feeling of discomfort in the cervical spine;
The constant symptoms
The symptoms are of a continuing nature tend to increase as the progression of the disease and can provoke ischemic attack in which there is a threat of vertebrobasilar stroke.
The main persistent symptoms VBN:
- headaches pressing or pulsating character, localized in the neck;
- dizziness (paroxysmal occurs, when a significant expression may lead to fainting);
- hearing loss;
- noise in the ears;
- the weakening of concentration and memory;
- blurred vision;
- blurred images, the presence of mist or flies before the eyes, possible double vision (split objects);
- weakness (especially in the second half of the day);
- excessive sweating;
- heat in the head, the hands, the face;
- feeling of foreign object in throat, pershenie.
The progression of the disease leads to the appearance of additional symptoms:
- difficult swallowing;
- disturbance of speech due to numbness of the mouth;
- loss of vision;
- sudden drops (so-called drop-attack);
- ischemic strokes.
How to recognize pathology in children?
Previously, experts believed that vertebrobasilar insufficiency is solely a disease of Mature age. However, later it turned out that the disease can affect children of all ages starting from 3 years.
Experts believe that the main reason for the development of VBN in childhood become congenital anomalies of the arteries (basilar or vertebral). To provoke the disease can also injury.
Parents should alert the following symptoms:
- frequent crying or anxiety;
- intolerance to heat, which causes severe dizziness up to fainting.
Diagnosis of the disease is problematic because of the diversity of clinical manifestations and their eharacteristic - the same symptoms can occur with other pathologies.
For confirmation of circulatory failure are a number of functional tests. For example, the patient is asked to follow a fast moving hand. Resulting headaches and dizziness are an indication of impaired blood flow in the vertebral artery.
Is the so-called trial de Klein. Confirmation of the diagnosis is the manifestation of the symptoms VBN as a result of turning the head sideways or when it istilting.
Of the methods of hardware diagnostics the following should be noted:
- Transcranial Doppler is considered the leading diagnostic method used to assess the status of cerebral circulation.
- Magnetic resonance angiography - allows visualization and learning most of the lesions of the brain vascular and neck area, to determine their nature, extent, duration.
- Spiral CT angiography is appointed for the comprehensive visualization of the lumen of the vascular, their walls.
- Digital subtraction arteriography remains the gold standard among the methods of visualization of the lumen of blood vascular.
- Rheoencephalography allows to study cerebral circulation.
- Neuropsychological testing with the use of special tests are done to assess the condition of the patient's perception of disease and the resulting restrictions
The choice of specific methods for the treatment of vertebrobasilar insufficiency depends on the nature of vascular lesions.
Mandatory measures are:
- daily measurement of blood pressure;
- following a special diet with restriction of quantity of salt, white bread, semi-finished products, smoked products, marinades, canned food, fatty and inclusion in the diet of seafood, tomatoes, citrus, peppers, sour berries, dietary cheese;
- Smoking cessation;
- exception of alcoholic beverages;
- physical activity of medium intensity.
In the absence of positive dynamics within 3-6 months it is necessary to conduct medication and physiotherapy treatment. At an early stage is assigned to outpatient treatment at a later - in-patient treatment for the prevention of strokes.
For the treatment VBN used:
1. Vasodilators (vasodilator drugs) for preventing obstruction of the vascular. Basically, they are administered in the transition seasons: fall or spring. Start with small doses, increasing them periodically. If one drug fails to get results, use multiple medications with the same action.
2. Antiplatelet agents - reduce blood clotting. Their application is necessary for the prevention of blood clots. The most popular drug is aspirin. However, this means has a negative impact on the gastrointestinal tract and may cause gastric bleeding. Therefore, acetylsalicylic acid is not recommended in diseases of the digestive system, as well as on an empty stomach. Itto replace clopidogrel, or dipyridamole ticlopidine.
3. Metabolic and nootropic agents used to improve brain functions. Most often used: glycine, piracetam, Actovegin, Cerebrolysin, seamax, nicergoline.
4. Drugs to regulate blood pressure is prescribed on a strictly individual basis.
5. Medications to relieve symptoms:
In which cases need surgery?
The necessity of surgical treatment is required in rare cases, severe illness. The surgery is performed to correct circulatory failure due to the reduction of the diameter of the vertebral or basilar arteries due to spasm, stenosis, compression.
While VBN performed the following typical operations:
- microdiscectomy - is assigned for stabilization of the spine;
- endarterectomy - its essence is to remove atherosclerotic plaque from diseased sheath of the artery;
- reconstruction of intervertebral discs using laser;
- angioplasty, where the artery is inserted into a special stent to prevent occlusion of the lumen and maintain patency and normal blood circulation.
Physical therapy and other non-pharmacological therapies
Optimal in the treatment of this disease is an integrated approach of physiotherapy and physical therapy along with the use of medications.
When VBN is high enough efficiency are different:
- A special massage helps improve blood circulation.
- Manual therapy.
- Reflexology - relieves muscle spasm. Very effective is acupuncture.
- Hirudotherapy is shown in many vascular pathologies.
- Special therapeutic exercises - strengthens the spine, removes spasms, improves posture.
- Wear a special neck corset.
You can read about the disease with similar symptoms called orthostatic hypotension.