Vertebrobasilar insufficiency: treatment options. Vertebrobasilar insufficiency what is this pathology? Vertebrobasilar insufficiency and manual therapy

Content

A disease such as ischemic stroke of the brain is the main cause of disability in our time. Pathology has a high mortality, and in surviving patients causes severe consequences of the cerebrovascular type. Exist different reasons disease development.

What is vertebrobasilar insufficiency

The spinal arteries emerge from the subclavian vessels located in the upper part of the sternum cavity and pass through the openings of the transverse processes of the vertebrae of the neck. Further, the branches go through the cranial cavity, where they join into one basilar artery. It is localized in the lower part of the brain stem and provides blood supply to the cerebellum and the occipital region of both hemispheres. Vertebrobasilar syndrome is a condition characterized by a reduction in blood flow in the vertebral and basilar vessels.

Pathology is a reversible violation of brain functions, which occurred as a result of a decrease in blood supply to the area fed by the main artery and vertebral vessels. According to ICD 10, the disease is called "vertebrobasilar insufficiency syndrome" and, depending on associated disorders, may have the code P82 or H81. Since the manifestations of VBN can be different, the clinical symptoms are similar to other diseases, due to the complexity of diagnosing pathology, the doctor often makes a diagnosis without proper justification.

Causes of ischemic stroke

Factors that can cause ischemic stroke in the vertebrobasilar basin include:

1. Embolism of various origins in the vertebrobasilar region or compression of the subclavian artery.
2. An arrhythmia in which thrombosis develops in the atria or other parts of the heart. At any moment, blood clots can break into pieces and enter the vascular system along with the blood, causing blockage of the arteries of the brain.
3. Atherosclerosis. The disease is characterized by the deposition of cholesterol fractions in the arterial walls. As a result, the lumen of the vessel narrows, which leads to a decrease in blood circulation in the brain. In addition, there is a risk that the atherosclerotic plaque will crack, and the cholesterol released from it will block the artery in the brain.
4. Presence in vessels lower extremities blood clots They can be divided into segments and, together with the bloodstream, enter the cerebral arteries. Causing difficulty in the blood supply to the organ, blood clots lead to a stroke.
5. A sharp decline blood pressure or hypertensive crisis.
6. Clamping of the arteries supplying blood to the brain. This can happen during carotid surgery.
7. A strong thickening of the blood caused by the growth of blood cells leads to difficulty in the patency of blood vessels.

Signs of a cerebral infarction

The disease is an acute violation of cerebral blood supply (stroke of the ischemic type) with the subsequent development of signs of a neurological disease that persist for up to a day. In transient ischemic attacks, the patient:

1. temporarily loses sight;
2. loses sensation in any half of the body;
3. feels stiffness in the movements of the arms and / or legs.

Symptoms of vertebrobasilar insufficiency

Ischemic stroke of the brain with localization in the vertebrobasilar basin is perhaps the most common cause of disability in people under 60 years of age. The symptoms of the disease differ and depend on the localization of the violation of the main functions of the vessels. If blood circulation has been disturbed in the vertebrobasilar basin, the patient develops the following characteristic symptoms:

• dizziness of a systemic nature (the patient feels as if everything around him is collapsing);
• chaotic movement eyeballs or its restriction (in severe cases, complete immobility of the eyes occurs, strabismus is formed);
• deterioration in coordination;
• tremor during the performance of any action (trembling of the limbs);
• paralysis of the body or its individual parts;
• nystagmus of the eyeballs;
• loss of body sensitivity (as a rule, occurs in one half - left, right, bottom or top);
• sudden loss of consciousness;
• irregular breathing, significant pauses between inhalations / exhalations.

Prevention

The human cardiovascular system is constantly under stress as a result of stress, so the risk of stroke increases. With age, the threat of thrombosis of the head vessels increases, so it is important to prevent coronary disease. To prevent vertebrobasilar insufficiency from developing, you should:

• to refuse from bad habits;
• with hypertension (high blood pressure), be sure to take medications to normalize blood pressure;
• timely treat atherosclerotic stenosis, keep cholesterol levels normal;
• eat a balanced diet, stick to a diet;
• control chronic diseases (diabetes mellitus, renal failure, arrhythmia);
• often walk on the street, visit dispensaries and medical sanatoriums;
• exercise regularly (exercise in moderation).

Treatment of vertebrobasilar syndrome

Therapy of the disease is prescribed after the doctor confirms the diagnosis. For the treatment of pathology are used:

• antiplatelet agents, anticoagulants;
• nootropics;
• analgesics;
• sedatives;
• correctors of blood microcirculation;
• angioprotectors;
• histamine mimetics.

Ischemic brain disease is dangerous because seizures (strokes) gradually become more frequent, and as a result, an extensive violation of the blood circulation of the organ can occur. This leads to a complete loss of capacity. To prevent coronary disease from becoming severe, it is important to seek medical help in a timely manner. In the treatment of vertebrobasilar syndrome, the main actions are aimed at eliminating the problem with blood circulation. The main drugs that can be prescribed for ischemic disease:

• acetylsalicylic acid;
• Piracetam/Nootropil;
• Clopidogrel or Agregal;
• Troxerutin / Troxevasin.

Folk methods for the treatment of coronary disease can only be used as an additional measure. In case of ulceration of an atherosclerotic plaque or stenosis of the carotid artery, the doctor prescribes a resection of the affected area, followed by a shunt. After the operation, secondary prevention is carried out. For the treatment of VBS (vertebrobasilar syndrome), therapeutic exercises and other types of physiotherapy are also used.

Physiotherapy

Vertebrobasilar insufficiency cannot be cured with drugs alone. Along with drug treatment of the syndrome, therapeutic procedures are used:

• massage of the occipital region;
• magnetotherapy;
• manual therapy;
• therapeutic exercises to eliminate spasms;
• strengthening the spinal trunk, improving posture;
• acupuncture;
• reflexology;
• hirudotherapy;
• use of a neck brace.

Treatment of cerebral ischemia

The most severe lesions in ischemic stroke that occurred in the vebrobasilar basin are brain stem injuries, since vital centers are located in it - respiratory, thermoregulatory, and others. Violation of the blood supply to this area leads to respiratory paralysis, collapse and other life-threatening consequences. Ischemic stroke in the vetebrobasilar basin is treated by restoring impaired cerebral circulation and eliminating inflammatory foci.

A stroke of the brain is a disease that is treated by a neurologist in a hospital setting. For therapeutic purposes, in ischemic stroke of the vertebrobasilar basin, a drug method is used. During the treatment period, the following drugs are used:

• vasodilators to relieve spasms ( a nicotinic acid, Pentoxifylline);
• angioprotectors that stimulate cerebral circulation, metabolism (Nimodipine, Bilobil);
• antiplatelet agents to prevent thrombosis (Aspirin, Dipyridamole);
• nootropics for enhancing brain activity (Piracetam, Cerebosin).

Drug treatment of ischemic stroke, which occurred in the vertebrobasilar basin, lasts for 2 years. In addition, it can be applied operational method disease therapy. Surgical intervention with vertebrobasilar syndrome is indicated for the third degree coronary disease if conservative treatment did not give the expected effect.

According to ongoing studies, severe consequences of ischemic stroke that occurred in the vertebrobasilar basin occur in two cases. This happens if the treatment was not started in a timely manner or did not give results in the later stages of the development of the disease. In this case, a negative outcome of vertebrobasilar insufficiency can be:

• mental retardation;
• isolation;
• asociality;
• difficulty in learning;
• migraine.

First aid for stroke

If you see symptoms of ischemic stroke in a person, call ambulance. Describe the symptoms to the dispatcher as accurately as possible so that the neurological team arrives on call. Next, give the patient first aid:

1. Help the person to lie down. At the same time, turn it on its side, substitute any wide container under the lower jaw in case of vomiting.
2. Measure BP. With an ischemic stroke that occurred in the vertebrobasilar basin, the pressure is usually elevated (about 180/110).
3. Give the patient an antihypertensive agent (Corinfar, Captopril, others). In this case, it is better to put 1 tablet under the tongue - this way the remedy will work faster.
4. Give a person with a suspected ischemic stroke 2 diuretic tablets. This will help relieve swelling of the brain.
5. To improve the metabolism of the patient's brain, give him a nootropic, for example, Glycine.
6. After the arrival of the ambulance team, tell the doctor exactly what drugs and at what dosage you gave to a patient with an ischemic stroke.

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The vertebral artery is located at the back of the spine and merges with the vertebral artery of the opposite side to form the basilar artery. These arteries supply blood, oxygen, and nutrients to vital brain structures such as the brainstem, occipital lobes, and cerebellum. Circulatory disorder in the above pool is called - vertebrobasilar insufficiency.

A condition called atherosclerosis reduces or stops the flow of blood through the vertebrobasilar system. Atherosclerosis is characterized by narrowing and blockage of the arteries due to the deposition of cholesterol in them. More on this: plaque, which consists of cholesterol and calcium, accumulates in your arteries, narrowing their lumen, cholesterol plaques form, and as a result, blood flow to the brain decreases. Cholesterol plaques can completely block the blood flow in the arteries, causing their absolute stenosis, which can cause a stroke. This can happen in any artery in your body. When this happens in the arteries of your vertebrobasilar system, it reduces blood flow to the structures at the back of your brain. This condition is known as vertebrobasilar insufficiency (VBI).

What causes VBN?

Vertebrobasilar insufficiency syndrome occurs when blood flow to the back of your brain is reduced or stopped. It is known that atherosclerosis is the most common cause diseases. In turn, an important etiological role is played by cervical osteochondrosis, features of the development of blood vessels of the vertebrobasilar basin: aplasia and hypoplasia of the vertebral arteries or the basilar artery, their pathological course (tortuosity).

Who is at risk of acquiring vertebrobasilar insufficiency syndrome?

Risk factors for the development of VBN are similar to those associated with the development of atherosclerosis. These include:

• smoking
• high blood pressure (hypertension)
• diabetes
• obesity
• age over 50
• family history
• elevated blood lipids (known as hyperlipidemia, dyslipidemia)

People who have atherosclerosis or peripheral artery disease also have increased risk development of vertebrobasilar insufficiency.

What are the symptoms of vertebrobasilar insufficiency?

Symptoms vary depending on the severity of the condition. Some symptoms may last for several minutes and some may become permanent. Common symptoms of vertebrobasilar insufficiency include:

• Loss or impairment of vision in one or both eyes
• Double vision
• dizziness (vertigo)
• numbness or tingling in the hands or legs
• nausea and vomiting
• slurred speech
• mental status changes, including sometimes confusion
• sudden, severe weakness throughout the body, called a drop attack
• loss of balance and coordination of movements
• difficulty swallowing
• weakness in any limb

Symptoms of acute vertebrobasilar insufficiency similar to a stroke. Apply for an emergency medical care if you are experiencing these symptoms. Immediate medical intervention will help increase your chances of recovery if these symptoms are the result of a stroke.

VBN diagnosis?

Your doctor will conduct an objective neurological examination, will ask you about your chronic diseases and may, in individual cases, prescribe:

• CT or MRI, BCS duplex scanning
• magnetic resonance angiography (MRA)
• blood test, coagulogram
• echocardiography
• in rare cases, a hospital doctor may also order a lumbar puncture.

The leading role in the diagnosis of NCC in the VBB is currently MRI and CT as well. When diagnosing vertebrobasilar insufficiency, it must be taken into account that the symptoms of the disease are often not specific and may be the result of another neurological or other pathology, which requires careful collection of the patient's sting, study of the history of the disease, physical and instrumental examinations to identify main reason its occurrence.

Distinguish USDG of the vessels of the brain and USDG of the vessels of the neck. Often they are carried out together, this creates a holistic view of the vessels supplying the brain with blood. The technique includes the study of carotid arteries, subclavian and vertebral arteries, neck veins, as well as the main arteries of the brain.

Picture at ultrasound examinations vessels of the head and neck is obtained due to the fact that ultrasonic waves emitted by special ultrasonic sensors, passing through a blood vessel, are reflected differently from erythrocyte cells, depending on the direction and speed of blood flow. The reflected waves are captured by an ultrasonic transducer and, after being converted into electrical impulses, are displayed on the monitor in real time in the form of graphs and color photographs that represent the flow of blood through blood vessels. Ultrasound of vessels allows you to see in real time the vessels "from the inside" and "outside", thereby making it possible to determine changes in blood flow in the vessels associated with spasm, narrowing or thrombosis.

During dopplerography it is possible to study only one function - the patency of the vessel, to clarify the degree of occlusion in%, in addition, ultrasonic duplex scanning of blood vessels (USDS), allows you to simultaneously evaluate two functions - to examine the structure of blood vessels and assess the speed of blood flow, and ultrasonic triplex scanning– study of three functions:

• study of the structure of blood vessels;
• evaluate blood flow
• accurate assessment of vascular patency in color mode.

Magnetic resonance angiography - MRA

MRA or magnetic resonance angiography is an informative and safe method of radiation diagnostics that does not use x-rays, it allows you to make a 3-D picture of the vascular bed of the brain.

This study allows you to timely prescribe the appropriate treatment and, thereby, improve the prognosis of the course of the disease; also, based on MRA data, you can conduct a preoperative examination in case of stenting or angioplasty.
MR angiography is used to diagnose:

• aneurysms and pathological anastomoses;
• stenosis and occlusion of blood vessels;
• vascular malformations;
• atherosclerotic changes in the arteries of the neck and brain.

MR angiography of the arteries of the brain is performed without contrast - this is an undeniable advantage.

To clarify the level and degree of damage to the auditory tract, a study of auditory evoked potentials is prescribed. Consultations of an ENT, audiologist, an audiogram are prescribed for the purpose of a differential diagnosis.
MRI of the cervical spine for the purpose of vertebrogenic effects on the vertebral artery.

Treatment of vertebrobasilar insufficiency

• quit smoking if you smoke
• dietary changes to control blood cholesterol levels
• weight loss if you are overweight or obese
• more active lifestyle, exercise therapy

In addition, your doctor may prescribe medications to help reduce your risk of stroke, the severity of the effects chronic ischemia brain in the WBB. In case of presence of stenosing atherosclerosis of the arteries of the head, high probability of thrombosis or embolism, risk of recurrent stroke in patients who have had a transient ischemic attack in the VBB, preventive measures are applied to eliminate the existing risk factors.

• These drugs are aimed at:
• blood sugar control
• lowering blood cholesterol levels
• improved blood circulation
• decrease in blood clotting

In the case of an acute neurological deficit - alternating syndromes, cerebellar insufficiency, negative scotomas, the patient should be urgently hospitalized in the vascular center and neurological department to exclude a stroke in the VBB.

According to the most effective drugs for secondary prevention of ischemic stroke:

• acetylsalicylic acid
• dipyridamole
• iclopidine
• chimes
• clopidogrel.

Aspirin at a dose of 75–150 mg/day remains the gold standard for stroke prevention to date.

Chronic vertebrobasilar insufficiency is often accompanied by elevated cholesterol levels and (or) dyslipidemia; atherosclerosis of the basilar or vertebral arteries may occur. In this situation, taking into account the level of cholesterol, % stenosis of the arteries of the vertebrobasilar basin and carotid arteries, comorbidity, the question of the need to prescribe statins, for example, atorvastatin at a dose of 10 mg / day, may be raised. LDL at 1.0 mmol / l leads to a reduction in the risk of all strokes by 10%, and at 1.8 mmol / l - by 17%. In general, according to a number of studies, the use of statins for 3-5 years can reduce the risk of stroke by 24-36% in chronic VBI.
Physiotherapy and moderate exercise significantly reduce the risk of cardiovascular disease and stroke It is statistically noted that people with moderate or high activity have a lower incidence of stroke compared to people with state of hypodynamia. Moreover, moderate physical activity reduces the risk in men and women by 20%, high physical activity - by 27%. This is due to the fact that a tendency to reduce blood pressure and body weight is formed, blood vessels expand, and glucose tolerance improves.

Correction of oxidative stress and neurometabolic therapy in VBI

Treatment of vertebrobasilar insufficiency with mexidol. Mexidol consists of two related and functionally significant compounds: 2-ethyl-b-methyl-3-hydroxypyridine and succinic acid. The presence of 3-hydroxypyridine in the structure of mexidol provides a complex of its antioxidant and membranotropic effects, the ability to reduce glutamate cytotoxicity, regulate the functioning of receptors, which fundamentally distinguishes mexidol from other drugs containing succinic acid.
The presence of succinate in the structure of mexidol distinguishes it from emoxipin and other 3-hydroxypyridine derivatives, since succinate is functionally significant for many processes occurring in the body and, in particular, is a substrate for increasing energy metabolism in the cell. The combination of two compounds with the necessary properties in the structure of Mexidol ensures its good permeability through the blood-brain barrier, high availability and impact on various targets, which results in a wide range of drug effects and high therapeutic potential. Mexidol is prescribed 500 mg / day parenterally for 2 weeks, followed by a switch to a tablet company of 125-250 mg (1-2 tablets) 3 times a day for at least 1 month. In addition, the neurometabolic drugs gliatilin, neuromidin, combilipen are used.

The antihypoxic drug Cytoflavin is used

Against the background of complex treatment of patients with vertebrobasilar insufficiency using Cytoflavin, there is a positive trend clinical symptoms: dizziness, visual disturbances, cephalic syndrome. It is characterized by accelerated rates of normalization in comparison with traditional methods of therapy. Cytoflavin has a regulatory effect on
peripheral circulatory resistance in the vertebral arteries, vasomotor reactivity in the basilar artery, which indicates an improvement in cerebrovascular reactivity and an increase in the compensatory possibilities of blood flow in the VBB pool.

Significant correction of blood pressure, antiplatelet therapy for various cardiac arrhythmias.

Surgical treatment of vertebrobasilar insufficiency

In some cases, the doctor may recommend a consultation with an angiosurgeon, who may prescribe surgery to restore blood flow to the back of the brain. Bypass or endarterectomy as options. Endarterectomy is the removal of an atherosclerotic plaque from an affected artery.

With stenosing cerebral atherosclerosis, in the case of critical stenoses of the arteries, the following surgical interventions are performed:

• angioplasty of the corresponding vessels
• stenting of the corresponding vessels
• endarterectomy
• imposition of extracranial and intracranial anastomoses.

VBI prevention?

Sometimes a disease cannot be prevented. This may be in older people who have had a previous stroke. However, there are measures that reduce the development of atherosclerosis and VBI.

These include:

• to give up smoking
• blood pressure control
• control blood sugar levels
• eating a healthy diet that is rich in fruits, vegetables, and whole grains
• physical activity

What is the long-term outlook for the disease?

The prognosis depends on your current symptoms, medical condition, and age. Younger patients who experience mild symptoms of vertebrobasilar insufficiency can be controlled with lifestyle changes and drug therapy and generally have a good prognosis. Old age, a weakened body, and chronic comorbidities can adversely affect the course pathological process. Discuss treatment options and medications with your doctor to help prevent or reduce symptoms of NDV.

At the bottom of the brainstem is the basilar artery, which is a collection of vertebral arteries.

The basilar artery provides blood supply to the brainstem, occipital hemisphere and cerebellum, and when the blood flow in this artery (and at the same time in the vertebral arteries) decreases, a person may experience visual impairment and even. This disease is called vertebrobasilar insufficiency (VBI) or vertebrobasilar syndrome.

Congenital and acquired disease: causes

It should be noted that VBN can be both congenital and acquired. The causes of the disease may be different. If we talk about the congenital syndrome of vertebrobasilar insufficiency, then the causes are fetal injuries during pregnancy, premature birth and possible other traumatic situations in which the vessels in the fetus could be damaged.

As for the acquired form of the syndrome, here it is based on diseases associated with and changes in the state vascular system in the region of the brain.

Most often, acquired vertebrobasilar insufficiency occurs under the influence of the following diseases:

• diabetes;
• thrombosis of the main artery;
• thrombosis of the vertebral artery;
• spinal injury;
• vascular wall disease (eg, vasculitis, arthritis);
• osteochondrosis of the cervical spine;
• Hughes-Stovin syndrome, etc.

Other causes and risk factors

At the moment, the following causes of VBN are considered:

• damage to the main vessels of the subclavian and innominate arteries, the extracranial part of the vertebrates;
• microangiopathy on the background diabetes, arterial hypertension;
• features of the structure of the vascular bed (from birth): aplasia of the vertebral arteries or their abnormal discharge, pathological tortuosity;
• trauma of the cervical vertebra;
• compression of the arteries by the cervical vertebrae;
• antiphospholipid syndrome.

On the background of what diseases the syndrome manifests itself

There are many factors that can contribute to the development of vertebrobasilar syndrome. In middle-aged and young people, this disease can manifest itself as a result of compression of the vertebral arteries by bone growths - osteophytes.

Also, a probable cause of the development of VBN may be a deformation of the canal of the vertebral artery or its underdevelopment (hypoplasia). Painful spasm of the vertebral artery also plays an important role in the development of this syndrome, as well as developmental anomalies (for example, an additional cervical rib).

In older people, it is often observed, which may result in the development of vertebrobasilar insufficiency syndrome. With atherosclerosis, atherosclerotic plaques form in the lumen of the arteries. As a result, the lumen of the arteries narrows, due to which the blood flow in their basin decreases.

In addition, blood clots form at the site of plaque divergence, and they further narrow the lumen of the arteries. Moreover, a blood clot can generally clog an artery, which naturally disrupts blood flow. In this case, a thrombus may arise somewhere in the cavity of the heart and migrate with the bloodstream to the vertebrobasilar basin. This process is called thromboembolism.

Quite rarely, the cause of the development of vertebrobasilar insufficiency is the dissection of the wall of the vertebral artery. This happens as a result of a neck injury or during manual therapy (with gross medical manipulations).

Actually, there are many reasons and ways for the development of this disease, and it is almost impossible to describe them all.

Vertebrobasilar insufficiency also often develops against the background of cervical osteochondrosis.

Osteochondrosis as a provocateur of the syndrome

One of the causes of VBN is cervical osteochondrosis. Due to poor blood circulation in the spine, the brain suffers, and on this basis a person feels strong,.

Along with this, a person can feel sick, the body becomes so weak that even walking is difficult. If, when squeezing the arteries of the spine, a person feels pain or it simply intensifies, then first of all this indicates the development of VBI against the background of osteochondrosis.

All of the above symptoms of vertebrobasilar insufficiency are the result of a deterioration in blood flow to brain areas: the cerebellum, the brain stem, the visual cortex of the occipital region. This is provoked by osteochondrosis. Its development can also cause spasm of the carotid and vertebral arteries.

As a result, the blood supply to parts of the brain is disrupted and, as a result, the head is spinning. There may also be other symptoms: numbness of the tongue, staggering when moving.

VBN syndrome in children

Despite the fact that this disease previously belonged to middle and old age, it often manifests itself in children. It is statistically determined that the syndrome may appear in children of the following ages: 3-4 years, 7-10, 12-14 years. Most often, the disease occurs due to congenital anomalies vertebral and basilar arteries. But other risk factors are not excluded, in particular, damage to a fragile children's spine during a fall and even playing sports.

There are certain signs in children by which one can determine or at least suspect the development of vertebrobasilar insufficiency:

• violation of the posture of the child;
• the child gets tired quickly, his drowsiness increases;
• the child hardly tolerates stuffiness - sometimes even to the point of nausea or fainting;
• the child sits in an uncomfortable position (squinting).

Even diseases that children had in early childhood can provoke VBN in children, for example,.

Features of the clinical picture

All symptoms of the disease proceed quite eloquently. Manifestations of the disease can affect most systems and organs. This is due to the fact that the pool of vertebrobasilar vessels provides oxygen-enriched blood to different functional areas.

The main symptom of the disease is. It is this that indicates a violation of the vestibular apparatus. Very often, dizziness is accompanied by noises in the hearing organs, vomiting and nausea. But this happens in advanced situations.

The duration of such attacks is very subjective. Speaking of noise, the information is contradictory. Some argue about an unpleasant whistle, others about a crackling, like a fire and the sound of the surf. Natural reflexes and the speech center are also affected by vertebrobasilar insufficiency. Speech becomes monotonous, almost unperceivable. The swallowing reflex may disappear completely. Such a manifestation should inspire significant anxiety for health.

Visual impairment is very likely, accompanied by a violation of sharpness, a feeling of ripples, bright colors and large objects are no longer perceived close. Drop attacks are becoming more frequent. Without a medical response, all manifestations become more frequent and even intensify.

The first 5 years of development of vertebrobasilar insufficiency, the patient will be prone to, having endured which, a person's life will proceed in a completely different rhythm.

All the symptoms of the affected organism will progress in groups, significantly reducing the quality and standard of living. They may appear and disappear unexpectedly. Even mild form causes the patient acute discomfort. The severe stage is completely bedridden. The period of the severe stage can last indefinitely.

Establishing diagnosis

It is very problematic to make an accurate diagnosis, this is due to the fact that the symptoms of VBN syndrome do not differ in any specific indicators from a number of other diseases. The diagnosis is based on a thorough study of the history of the development of the disease and patient complaints.

A complete instrumental and physical examination is carried out. The main method of examination -. It is necessary to assess the velocity of arterial blood flow in the neck and head. The method is completely painless. The arteries of the spine are also subject to detailed examination, since they are often affected.

To clarify the causes of the onset of the disease, and are prescribed. But these studies are not very informative, since the small size of the arteries is very poorly visualized in the image.

The most commonly prescribed treatment is in combination with medications. Certain forms of NDV cannot be treated with any drugs. It is very important to establish all causes as soon as possible. Treatment is prescribed strictly-individually for each patient.

When making a diagnosis of vertebrobasilar syndrome, the following drugs are used for therapy:

The following methods of treatment and rehabilitation are used: massage, therapeutic exercises, magnetotherapy, neck corset, hirudotherapy, acupuncture, etc.

Surgical treatment is prescribed quite rarely. It is carried out in order to improve blood circulation in the vertebral and basilar arteries. A very common method is angioplasty, which prevents the arterial lumen from closing with the help of a special stent. Microdiscectomy stabilizes the spine.

Folk remedies are used only in combination with medications. These remedies include garlic, vitamin C, horse chestnut, hawthorn, mint, yarrow, birch buds, immortelle, etc.

It is important to treat diseases that provoked vertebrobasilar insufficiency. You should carefully consider the diet (refuse all sausages, white bread, sour / spicy, canned food, fatty and fried), minimize the amount of salt consumed, overcome bad habits, control pressure, pay attention to moderate exercise and walks.

Swimming should be done if possible. It is very important not to sit for a long time in uncomfortable positions. Protect yourself as much as possible. Mattress, pillow and bed should be as comfortable as possible.

Vertebrobasilar insufficiency (VBI) is a deterioration in the blood supply to the brain, causing a violation of its functions.

Such a pathological condition is due to the obstructed movement of blood through the vertebral arteries, which transport oxygen and nutrients to the brain tissues.

Not getting enough oxygen to the brain causes its dysfunction. These changes are reversible: with timely detection and treatment, a person returns to normal life.

The brain is supplied with blood through several pathways, including through the vertebral arteries, originating from the right and left subclavian. Arteries rise on both sides of the spinal column through the openings of the cervical vertebral processes, enter the cranium and join there.

A change in blood circulation in any segment of the vertebrobasilar basin will certainly affect the blood supply to the brain.

It was noted that the deterioration of blood circulation in the right-sided artery is less common than in the left-sided one. This is due to the features anatomical structure vertebral artery, located on the left: atherosclerotic formations are more often detected in it.

The causes of the development of the disease are divided into congenital and acquired.

TO congenital causes relate:

• anomalies in the development of the fetus;
• hypoxia of the unborn child;
• complications during childbirth, which led to the deformation of the vessels of the child.

Of the acquired factors that provoked the syndrome of vertebrobasilar insufficiency, there are:

• squeezing of the vertebral artery as a result of injury of the cervical vertebrae, herniated discs, hypertrophy of the scalene muscle, spondylarthrosis;
• damage to small vessels of the brain, provoked by diabetes mellitus;
• dissection of the arterial walls;
• high blood pressure;
• the formation of blood clots in the vertebral artery;
• inflammation processes affecting the vascular walls;
• antiphospholipid syndrome;
• fibromuscular dysplasia.

Pathology also often occurs against the background of cervical osteochondrosis. Due to the deformation of the vertebrae of the neck, the arteries are pinched, and the brain cells at these moments experience a lack of oxygen.

Symptoms

Symptoms of vertebrobasilar insufficiency are conditionally divided into 2 types: temporary and permanent.

Temporary symptoms last from 3-4 hours to 3-4 days, they appear at moments.

These signs are:

• sharp pain in the occipital region;
• dizziness, loss of balance;
• muscle tension in the neck;
• hypertensive crisis.

Permanent manifestations tend to increase with the aggravation of the disease. If there is no therapy, then the patient's well-being may deteriorate up to ischemic attacks on an ongoing basis, which significantly increases the risk of ischemic stroke.

Permanent manifestations of VBN:

• pressing pain in the back of the head;
• regular dizziness;
• partial deafness, stuffy ears;
• distracted attention;
• memory disorder;
• loss of vision (blurred borders and doubling of objects);
• lethargy, weakness;
• excessive irritability;
• increased heart rate;
• perspiration and feeling of a stuck object in the throat;
• sweating;
• weakness in the legs.

Separately, the symptoms that manifest themselves in children are also highlighted. The disease most often develops in the age period from 3 to 14 years and has quite pronounced manifestations.

The characteristic signs of vertebrobasilar insufficiency in a child are:

• insomnia and vice versa - constant drowsiness;
• tearfulness;
• fast fatiguability;
• poor tolerance to hot weather;
• nausea and dizziness;
• posture disorder.

Diagnostic methods

If these symptoms occur, you should consult a neurologist. Diagnosis of the syndrome of vertebrobasilar insufficiency is often difficult - the symptoms of this pathology are similar to the symptoms of many other diseases.

Since the occurrence of VBI is a consequence of an already ongoing disease (for example, arterial hypertension, obstruction of the intracranial arteries), diagnostic measures are aimed at identifying the root cause.

The doctor will examine the patient using functional tests. These include - observing a rapidly moving object, turning the head to the left and right, tilting the head back. If at such moments the patient begins to ache and feel dizzy, then this indicates a violation of the movement of blood in the vertebral artery.

Next, the doctor prescribes blood tests to establish the causes that provoked VBI. A blood test includes determining the level of glucose, studying the electrolyte and lipid composition, the presence of antibodies to phospholipids, and examining the indicators of the homeostasis system.

To accurately determine the diagnosis, in neurology, methods of hardware diagnostics are used:

1. Doppler ultrasound examination of the cervical and head vessels: allows you to see the patency of the vessels and track the movement of blood in them.
2. Computed and magnetic resonance imaging. These methods allow you to see areas of damage, even small sizes.
3. Angiography is a technique using a contrast agent to detect deterioration in blood flow in the vertebrobasilar basin.
4. Spiral computed angiography: performed to visualize the vessels and their walls, to determine vascular patency.

Self-diagnosis is not recommended. It is necessary to consult with a specialist in order to differentiate VBI from other pathologies that have similar manifestations.

Treatment

Treatment tactics are determined based on the cause of the disease and the degree of vascular damage.

Initially, it will be enough for the patient to live according to the new rules:

• Quit smoking and drinking alcohol.
• Adhere to a special diet, which implies the rejection of salted, smoked, pickled and spicy foods, convenience foods, canned food. Add seafood, dried fruits, citrus fruits, fat-free cottage cheese, bell peppers to the menu.
• Measure blood pressure every day.
• Fulfill physical exercise moderate severity.

Subject to these recommendations, the patient needs to monitor his condition for improvement. If after 3-4 months no positive dynamics is observed, then in this case the doctor applies an integrated approach to treatment: he prescribes medications, physiotherapy and exercise therapy.

On initial stage the disease is usually treated on an outpatient basis. In case of deterioration of the condition and severe dysfunction, the patient is hospitalized in the inpatient department of neurology.

The prognosis of recovery largely depends on the cause that provoked the disease.

If the disease is in the compensation stage, then there is every chance to achieve a satisfactory quality of life, with decompensation and the development of ischemic stroke - about 20% of patients experience disability and complete disability.

Medical therapy

Medicines, their dosage and course of treatment are selected individually for each patient.

The drugs used in the composition complex therapy with vertebrobasilar insufficiency:

1. Vasodilators (vasodilators) are used to prevent vascular obstruction. Usually they are used in the spring-autumn period, starting with a small dosage and gradually increasing it. If the prescribed remedy does not give the desired effect, then analogues are used.
2. . Taking this group of drugs is needed to reduce the risk of blood clots. Aspirin is considered the most popular remedy, but in the presence of diseases gastrointestinal tract its use may be limited. Of the analogues, Clopidogrel, Ticlopidin, Dipyridamole are prescribed.
3. Means to enhance brain nutrition: Glycine, Piracetam, Semax.
4. Drugs to improve metabolism in brain tissues: Cavinton, Korsavin, Cinnarizine, Actovegin.
5. Medicines to normalize blood pressure.

Additionally, medications are also prescribed that eliminate unpleasant symptoms:

• sedatives;
• drugs to normalize sleep;
• analgesics;
• antidepressants;
• remedies for dizziness and vomiting.

With exacerbation of vertebrobasilar insufficiency, Vinpocetine can be administered intravenously at a dosage of 5, 10 or 15 mg, after dissolving it in 500 ml of saline. As the acute phase of the condition is removed, the patient switches to taking Vinpocetine orally.

Physiotherapy

Simultaneously with the use of drug therapy, the patient is prescribed physiotherapy.

It includes the following methods:

1. Therapeutic massage techniques, carried out in a course of 10-15 sessions: help to relax the muscles, eliminate the clamping of the arteries and resume the natural movement of the blood.
2. Manual therapy.
3. Acupuncture - needles located on biologically active points help relieve muscle spasms.
4. Magnetotherapy - under the influence of magnetic impulses, muscle relaxation occurs, pain syndrome decreases.
5. Hirudotherapy - treatment with leeches is effective against vascular pathologies.
6. Usage orthopedic corset for the neck.
7. Therapeutic gymnastics helps to strengthen the spinal column, restore posture.

exercise therapy

Physical therapy deserves special attention. It is a set of specially selected exercises aimed at strengthening the muscles in the problem area and general strengthening of the body.

Physical education should be done on a regular basis, preferably every day.

All exercises are easy to perform. The basic rule of therapeutic gymnastics is that you need to move smoothly, without jerks and efforts. During physical activity, you need to follow the rhythm of breathing: breathe through your nose at a calm pace.

The most effective gymnastic techniques for VBI:

1. Stand with a straight back, put your socks together. Tilt your head forward, trying to reach your chest with your chin. Hold this position for 10 seconds and return to the starting position.
2. Keeping your shoulders at the same level, you need to tilt your head to the right, trying to lower your ear to your shoulder. Hold this position for 10 seconds and return to the starting position. Duplicate the same manipulation on the left side.
3. Gently and slowly turn your head first in one direction, then in the other.
4. Standing straight, pull your head up. Hold the position for 10 seconds, then relax.
5. Stand up straight with arms along the body. You need to raise your hands up and put your palms together for 10 seconds. Then lower your hands.
6. Alternately raise both legs, fixing the position with the raised leg for 10 seconds.
7. Stand on one leg, keeping your balance for as long as possible. If this action does not cause difficulties, then you can perform the exercise with your eyes closed. Repeat the same manipulations with the second leg.

The number of repetitions of each exercise is 10 times. Regular therapeutic exercises in combination with medication and physiotherapy help to cure chronic VBN.

Surgical intervention

At the extreme stages of the disease, when no therapeutic methods help, the patient is recommended surgery. Surgical intervention is carried out in order to restore blood circulation, impaired due to a decrease in the arterial lumen.

Types of operations performed with VBN:

• Microdiscectomy - the technique is used to stabilize the vertebrae, remove hernial formations;
• Endarterectomy - excision of the plaque is performed along with the damaged arterial area;
• Laser restoration of intervertebral discs;
• Angioplasty is the insertion of a special stent to avoid blockage of the lumen in the artery, and thereby maintain unimpeded blood circulation.

A complex of symptoms indicating cerebral focal changes is called vertebrobasilar insufficiency in medicine - VBN. These changes are reversible and therefore amenable to drug treatment. This condition is caused by a constant deficiency of blood supply to the brain, due to the pathology of the vertebral and basilar arteries.

What is the vertebrobasilar system

The arteries responsible for supplying food to the brain are diverted from the right innominate and left subclavian arteries. They go through the holes between the processes on the cervical vertebrae, penetrate the skull, where they converge into a single basilar artery. Its location is at the bottom of the brain stem. This makes up the vertebrobasilar system, its share in the total brain blood flow is 30%.

In the ICD-10, vertebrobasilar syndrome is coded G45. This includes transient transient seizures in the arteries - code G45.0, many cerebral artery syndromes - code G45.2. Codes left for other transient attacks - code G45.8, unspecified ischemic attacks - code G45.9. They are left so that practicing neuropathologists can make additions and clarifications to the diagnoses already available in ICD-10.

Causes of insufficiency

The blood flow decreases in any part of the VBN due to external compression, or due to a narrowing of the internal section. This causes a lack of nutrition of the brain, causes it clinical manifestations. Appearance clinical signs becomes an indication for the diagnosis of VBN and requires the start of its treatment.

Risk factors for the development of VBN

Vertebrobasilar deficiency is divided into congenital and acquired. The causes that reduce blood flow are vascular and external.

Important reasons for the formation of VBI:

• the presence of atherosclerosis, accompanied by arterial stenosis or occlusion;
• the appearance of vascular anomalies is pathological tortuosity, a violation of the anatomy in the branches from the aorta;
• inflammation of the vascular walls;
• increase in blood pressure;
• angiopathy of diabetics;
• neck injuries;
• hernia between the vertebrae in the cervical region;
• spasms in the muscles;
• dystrophic lesions.

Attention!

One of the factors causes vertebrobasilar insufficiency against the background of cervical osteochondrosis - a common pathology.

Symptoms

Vertebrobasilar insufficiency - what it is and what clinical picture it presents is known to neurologists who treat this pathology.

The symptomatology is characterized by a variety of symptoms, the manifestation of which is due to the area where the shortage of blood supply has formed:

• persistent dizziness, accompanied by visual impairment - flickering of flies in the eyes and above the field of view, doubling the visible image;
• violations of stability, staggering, throwing to the sides;
• decrease in the functions of concentration, attentiveness;
• sound noises, a drop in auditory perception;
• forgetfulness of short-term memory;
• acute pain in the back of the head, accompanied by nausea;
• causeless bouts of weakness, high fatigue;
• increased irritation;
• high sweating;
• cardiopalmus.

Such factors cause ischemic attacks, microstrokes. They are followed by an ischemic stroke.

Transient attacks are pronounced, but their symptoms subside quickly.

They are expressed:

• numbness in the mouth, which makes speech slurred;
• difficulty in swallowing, which is why a sick person cannot drink water, drink medicines;
• weakness in the legs, falls, accompanied by fainting;
• disorientation in the place, in the events taking place;
• involuntary tremor of the arms, legs; the whole body may tremble;
• general limitation of mobility.

With such manifestations of impaired blood circulation, ischemic stroke occurs. Often the symptoms pass quickly without leaving a serious complication.

Vertebrobasilar insufficiency in children

For the main reason for the development of VBN is birth trauma. Children's vertebral deficiency syndrome can be corrected without the use of medications. Complicated situations require the intervention of surgeons.

Children's VBN is determined by age. It manifests itself with symptoms:

• curvature of the spine;
• injuries in sports training;
• fatigue, and the child really wants to sleep;
• feeling unwell in stuffiness, to fainting;
• dizziness with nausea.

Diseases of early childhood - perinatal encephalopathy, birth trauma, are provocateurs of the formation of VBI. Timely detection allows you to quickly establish a diagnosis, and therapy will give a favorable prognosis.

Diagnosis of VBN

The variety of symptoms of VBI is not particularly specific. It can be confused with manifestations of other conditions. But an experienced neuropathologist, collecting an anamnesis and analyzing the patient's complaints, will definitely suspect VBI and will give a referral for a full examination.

Assessing the neurological condition, the neuropathologist sees signs of disorders:

• reduced muscle tone;
• carrying out a test for hyperventilation; signs appear in clear expression;
• conducting a test for dizziness, provocation with hand movements, rotation, pronounced symptoms appear;
• conducting a Klein test shows chronic disorientation, delayed reactions, speech difficulties;
• carrying out a Hauntan test, the patient may lose balance, hands involuntarily drop down - these are obvious
• signs of damage to the arterial circulation of blood.

Laboratory examinations are carried out:

• blood test for electrolyte composition;
• blood test for biochemistry;
• a blood test for glucose;
• lipidogram;
• blood test for homeostasis;
• a blood test to detect antibodies to phospholipids.

An accurate diagnosis is established after instrumental research methods:

• Doppler ultrasound - shows the status;
• CT and MRI visualize focal changes;
• angiography shows dysfunction of the blood supply;
• REG - examines the supply of blood to the brain;
• MRI angiography - visualizes blood vessels without the use of contrast agents;
• infrared thermography - assesses the state of blood vessels with thermal fields.

Additional methods of VBN are:

• consultation with an otolaryngologist;
• consultation of an otoneurologist;
• oculist consultation,
• examination by a psychoneurologist;
• examination by a cardiologist.

Interesting!

A complete examination of a patient with suspected VBN allows doctors to establish an accurate diagnosis and find the causes of the disease.

Treatment

Therapeutic tactics are based on the causes of VBI, the degree of arterial damage is taken into account, clinical manifestations and their severity are taken into account. Pathology treatment begins on an outpatient basis. If the indicators clinical picture they talk about a transient attack, the examination shows persistent dysfunction of the vertebrobasilar system, the patient is hospitalized in neurology. Successful therapy depends on adjusting the lifestyle.

The patient is required to:

• follow a diet, limit the use of salty, smoked foods; include more vegetables, fruits, boiled meat;
• citrus fruits, kiwi are definitely needed in the diet;
• regularly monitor blood pressure;
• give the body physical exercise;
• switch to walking mode.

Attention!

Even a change in the mode of life will give noticeable improvements in a person's well-being.

Conservative therapy

The prescription of medications depends on the cause of VBI.

Therapeutic practice involves the appointment of:

• drugs with a vasodilating effect to relieve spasms in the vessels;
• drugs that lower blood pressure;
• means of antiplatelet properties;
• means of anticoagulant properties;
• nootropics – improve brain function;
• angioprotectors;
• if necessary, drugs against vomiting;
• if necessary - painkillers;
• if necessary - sleeping pills;
• if necessary - means against dizziness.

Important!

The attending physician chooses medicines individually for each patient. This is due to the manifestation of the clinical picture, disturbing the patient's conditions and pain.

Surgical treatment

When drug therapy does not give the desired improvement, and clinical manifestations continue to grow, doctors decide on the need for intervention by surgeons.

If VBI is caused by internal compression, carry out:

• microdiscectomy - performed by neurosurgeons, excising a hernia between the vertebrae to stabilize the state of the spinal column;
• reconstruction of discs between the vertebrae with a laser.

If the examination shows the presence of narrowing in the lumen of the vessels closed by plaques, an endarterectomy is performed when the plaques are removed. When arterial stenosis is diagnosed, stenting is performed - a special stent is inserted into the vessel, expanding the lumen.

Physiotherapy

At external causes VBN physiotherapy treats:

• massages;
• reflexology;
• magnetotherapy;
• hirudotherapy;
• wearing corsets;
• manual therapy.

Physiotherapeutic methods for VBI are used for a long time. Therapy should be carried out continuously, with a supporting effect. The medications used usually have a cumulative effect and will start working after a few weeks.