Vertebro- basilar insufficiency is a reversible violation of brain function caused by a decrease in blood supply.
- Acute cerebrovascular accident
- High blood pressure
- Vascular inflammation ( Takayasu disease , for example)
- Artery dissection
- Fibromuscular dysplasia
- Crush of the subclavian artery hypertrophic scalene muscle.
- The presence of congenital malformations of the vascular bed
- Compression of the vertebral artery due to lesions of the cervical spine ( spondylolisthesis , disc herniation)
- Vertebral and / or basilar artery thrombosis
- The defeat of the small cerebral arteries caused by sugar diabetes
The picture of vertebro- basilar insufficiency is extremely diverse. One of its most frequent manifestations is sudden dizziness. The frequency of this feature may be due to the peculiarities of the blood supply to the vestibular apparatus, which is very sensitive to insufficient blood supply.
In most patients with vertebro- basilar insufficiency, dizziness manifests itself in the form of a sense of rotation or rectilinear movement of surrounding objects or one’s own body. Usually dizziness occurs quickly and lasts from several minutes to hours. As a rule, it is accompanied by disorders in the form of nausea, vomiting, sweating, a change in heart rate and blood pressure. In some cases, the patient experiences a feeling of falling through, cradling, and fluctuation of the surrounding space. Movement disorders in patients with circulatory disorders in the vertebro- basilar system consist in the development of weakness and awkwardness in the limbs. A common manifestation is unilateral hearing loss – neurosensory hearing loss.
Diagnosis of vertebro- basilar insufficiency is a neurological examination and requires clarification of the leading causes of its development ( arterial hypertension , impaired patency of the main or intracranial arteries, etc.).
The state of the blood flow in the main arteries of the head and the intracerebral vessels is assessed using Doppler ultrasound. Modern combined systems, including Doppler and duplex scanning, allow to assess the state of the vertebral arteries.
Valuable information provides functional tests with hyperventilation (evaluation of the functional reserve of cerebral circulation). Infrared thermography and rheoencephalography have much lower diagnostic value.
Evaluation of the state of the cervical spine is carried out on the basis of x-ray; Functional tests with flexion and extension make it possible to identify spondylolisthesis . Neuroimaging study (computed tomography or magnetic resonance imaging) is indispensable for detecting herniated intervertebral disc, other structural lesions of the spinal cord and spine.
Perhaps the use of Mr angiography, which allows to obtain information about the state of the vascular bed of the brain, without resorting to intravenous administration of contrast agents. In some cases, valuable information can be obtained by vestibular examination, registration of short- stemming evoked potentials for acoustic stimulation, audiometry. Of particular importance are studies of the coagulating properties of blood and its biochemical composition (glucose, lipids).
The main directions of treatment of vertebro- basilar insufficiency are determined by the nature of the vascular lesion. Regular (daily) monitoring of blood pressure and compulsory correction of the diet (restriction of salt in the diet), elimination of alcohol consumption and smoking, and measured physical activity are necessary.
If there is no positive effect for 3-6 months, drug therapy should be carried out. Treatment begins with diuretics, ACE inhibitors ( captopril , enalapril ), calcium channel blockers ( amlodipine , felodipine ), beta-blockers (atenolol, metoprolol , bisoprolol ). If necessary (lack of effect of treatment, poor tolerability of drugs) is replaced by a drug from a different pharmacological group. If in this case there is no positive effect on reducing blood pressure, it is necessary to use complex therapy (diuretic + ACE inhibitor, diuretic + b-blocker, beta-blocker + calcium channel blocker).
In those patients in whom the cause of vertebro- basilar insufficiency is atherosclerosis, an effective way to prevent seizures is to restore the properties of the blood and prevent the formation of blood clots. Acetylsalicylic acid is the most common anti- thrombotic drug . Currently, it is believed that the optimal therapeutic dose is taking the drug 0.5-1.0 mg / kg body weight per day (the patient should receive 50-100 mg of acetylsalicylic acid daily).
The impossibility of using acetylsalicylic acid requires the use of other drugs, in particular, dipyridamole . The daily dose may vary from 75 to 225 mg (25 to 75 mg 3 times a day), in some cases, the daily dose may be increased to 450 mg. Dipyridamole is taken 1 hour before meals, the tablet is not chewed and washed down with a small amount of water. The duration of the course of dipyridamole is usually 2-3 months. Cancellation is done gradually, the dose is reduced for 1-2 weeks. The drug is contraindicated in acute myocardial infarction , angina pectoris rest, severe congestive heart failure, heart rhythm disorders.
Modern preparations of antithrombotic action are clopidogrel, ticlopidine. Improving cerebral circulation can contribute to nicergoline . Maintenance dose of nicergoline is set individually and is 5-10mg 3 times a day. Performed well cinnarizine. Treatment begins with the minimum dosage (12.5 mg 3 times a day) with a gradual increase in the dose ( 25-50mg 3 times a day after meals). Used piracetam 0.8 g 3 times a day for 2 months, Cerebrolysin 5-10 ml intravenously 5-10 injections per course of therapy.
A very convenient combination is Fezam , containing 25 mg of cinnarizine and 400 mg of piracetam . The undoubted advantage of the drug is ease of dosing. The effect is observed when taking 1-2 capsules 3 times a day. The duration of the course of treatment is determined individually and depends on the nature and severity of the neurological deficit and averages 1.5-3 months. Carnitine hydrochloride is administered intravenously 5-10ml of 20% solution in 300-400ml of physiological (isotonic) solution, treatment of 8-12 injections.
To eliminate the dizzy spells when -bazilyarnoy vertebrobasilar insufficiency is well established betahistine. Betahistine is used in 8-16 mg 3 times a day. It is advisable to begin treatment with small doses of the drug, if necessary, gradually increasing them. The course of treatment is long (2-3 months). In order to reduce the intensity of episodes of dizziness and associated symptoms (nausea, vomiting), especially those provoked by movement, meklozin is prescribed . The daily dose is variable and ranges from 25 to 100mg.
The prognosis of vertebro- basilar insufficiency is determined by the nature and severity of the underlying cardiovascular disease, the degree of damage to the vascular bed, and the possibilities of providing bypass circulation of the brain.
Progressive narrowing of the arteries, persistent arterial hypertension in the absence of adequate therapy are precursors to a poor prognosis. These patients have a high risk of stroke or dyscirculatory encephalopathy with persistent neurological deficit.
A satisfactory condition of the vascular system of the brain, an adequately planned treatment tactic is associated with a relatively mild course of vertebro- basilar insufficiency and a favorable prognosis.