One of the fairly common diseases of the central nervous system is vertebrobasilar insufficiency. This condition is characterized by a number of unpleasant symptoms. In order for the treatment to be as effective as possible, it is necessary to approach the solution of the problem in a complex manner. An experienced doctor will prescribe the appropriate therapy after a series of diagnostic procedures. What is this ailment, what are its causes, manifestations and methods of treatment will be discussed further.
General Description
Basilar insufficiency according to ICD-10 belongs to class 5 "Vascular diseases of the nervous system" and has the code G45. In this document, the disease is called "Vertebrobasilar Arterial System Syndrome".
The disease is a disorder of brain function that is reversible. This condition is caused by a decrease in the intensity of blood circulation in a certainthe area of the brain that is fed by affected arteries (vertebral and basilar).
Vertebrobasilar insufficiency is manifested by specific neurological symptoms. This reflects acute transient ischemia of the brain in those areas where the vascularization of the main and vertebral arteries is determined. Some changes in the pathological picture can be detected in patients after the cessation of an ischemic attack.
Manifestations of this disease are varied. Several symptoms may appear. It is sometimes impossible to single out the main one. Studying the symptoms of acute basilar insufficiency, doctors identified two categories of manifestations of the disease:
- Paraximal - syndromes appear during the onset of an ischemic attack.
- Permanent - characterized by a long manifestation, observed in the patient in the period between attacks.
In the arteries of the vertebrobasilar system, both ischemic transient attacks and ischemic strokes of varying degrees of intensity can occur. Including they can be lacunar.
Reason for development
Basilar insufficiency syndrome can develop for various reasons. The main one is various lesions of the vertebral arteries. They are of a different nature. Also, pathological changes can be determined in the subclavian and innominate arteries.
Such manifestations are explained by the development of stenosis, which is characterized by atherosclerotic nature. It should be noted that quiteoften there is vertebrobasilar insufficiency against the background of cervical osteochondrosis. There is a compression of the vertebral arteries, which are compressed by the vertebrae. The latter, due to the characteristics of the disease, have an altered configuration. This, for example, can be osteophytes or spondylosis. Compression caused by such factors can be considered an independent cause of the development of vertebrobasilar insufficiency.
It is worth noting that the characteristic symptoms of this disease are not always caused by poor patency of the vertebral arteries. The most common causes of reduced blood circulation in this area, in addition to those already mentioned, are:
- Cervical disc herniation.
- Spasm of the muscles in the neck.
- Subluxations of the cervical vertebrae.
- Genetic, hereditary developmental anomalies.
In addition, in some cases, the cause of basilar insufficiency can be a neck injury of varying severity.
Clinical manifestations
Acute vertebrobasilar insufficiency can present with a variety of symptoms. They can be conductive (sensitive, pyramidal), vestibular, visual. The functions of the cranial nerves may also be impaired. Depending on the severity and combination of symptoms of basilar insufficiency, the size of the area affected by ischemia and its localization are determined.
The blood supply to the brainstem and cerebellum can vary slightly from person to person. Therefore, the describedclassic neurological manifestations in reality almost never occur in their pure form. With repeated episodes, the side of sensory and motor deviations and disorders may change.
One of the most common symptoms is impaired motor function. Patients may experience paresis, impaired coordination. Dynamic ataxia is combined in the limbs with intentional tremor. Gait may be disturbed or muscle tone may decrease asymmetrically.
Sensory disorders are often manifested by full or partial anesthesia in the limb, half of the trunk. Paresthesias may appear. In 25% of patients, there is a superficial or deep impairment of sensitivity.
It is worth noting that it is not always possible to determine the involvement in pathological processes of certain areas of the blood supply of the vertebral arteries, carotid arteries by clinical manifestations. Therefore, when diagnosing, it is impossible to do without neuroimaging methods.
Visual disturbances, dizziness
Among the symptoms of basilar insufficiency, one of the most common manifestations is visual impairment. Such a deviation can be manifested by the loss of fields. Photopsies may appear.
When the circulatory system of the brain stem is affected, disturbances appear in the region of the nerves of the cranium. There may be disorders of the oculomotor type. This may be, for example, strabismus, vertical separation of the eyeballs, etc. This category of disorders also includes peripheral paresis of the muscles of the face and bulbar syndrome.
The listed manifestations can be observed in different combinations. Rarely, only one syndrome occurs. Lesions can be caused by a combination of circulatory disorders in the vertebral and carotid arteries.
Another common symptom of vertebrobasilar insufficiency is dizziness. This state can last several minutes, but sometimes it can reach several hours. This is due to the morphological and functional features of the human circulatory system, high sensitivity to ischemia.
Dizziness can be of different types. Sometimes there is a systemic violation of the vestibular apparatus. But there is also a mixed nature of dizziness. This is manifested by a sensation of rotation or movement in a straight line of objects surrounding the patient, as well as his own body. This often causes nausea, and sometimes vomiting. The patient has hyperhidrosis, increased heart rate, changes in blood pressure.
Over time, the intensity of discomfort decreases. But focal symptoms, such as ataxia, may appear. They are becoming more pronounced, becoming persistent, permanent.
Hearing impairments
Studying the symptoms and treatment of vertebrobasilar insufficiency, it is worth noting another frequent manifestation of pathology. These are hearing impairments. It can noticeably decrease, noise appears in the ears. There may also be a feeling of congestion. Similar symptoms most often appear when ischemia affects the zone of the inferior anterior artery.cerebellum. It supplies blood to the dorsolateral areas of the brain, as well as the cerebellar peduncle. This artery also feeds the inner ear, the cochlear nerve.
Auditory and vestibular disorders, manifesting systemically, are often accompanied by other neurological manifestations. This indicates a pathology of nutrition of the cerebellum and brain stem.
Much less often, a patient develops an isolated lesion of the ischemic type of the inner ear or nerve. In this case, the patient has an acute form of hearing loss, as well as dizziness. There is no neurological deficit. A similar situation occurs due to a decrease in the patency of the auditory artery, which is the terminal branch of the inferior anterior cerebellar artery. There are no anastomoses here.
Such an isolated violation is very rare. A comprehensive diagnosis is required, since such a manifestation sometimes indicates the onset of the development of an extensive stroke, which is accompanied by a significant deficit of the neurological type.
Diagnosis
To prescribe an effective treatment regimen for basilar insufficiency, the doctor prescribes a comprehensive examination. To date, one of the best methods of neuroimaging is MRI. With the help of this procedure, it is possible to identify even minor foci of pathology.
If it is required to differentiate the nature of the stroke, CT is used. But this procedure will be less informative,if you need to study the structure of the structures of the cranial posterior fossa. Today, it is possible to explore the vascular bed using magnetic resonance angiography. However, radiopaque angiography is superior to this procedure in terms of information content.
If the patient has symptoms of damage to the main artery, only the method of cerebral selective angiography will be informative. If the narrowing of the walls and the decrease in vascular patency are caused by atherosclerosis, especially in the distal vertebral sections, digital angiography of the arteries is a fairly informative technique. An intravenous similar procedure will not be informative in this case.
However, it is worth remembering that angiographic studies increase the risk of stroke. Therefore, they are prescribed with extreme caution.
In the course of ultrasound today, a Doppler installation and a triplex scanner are used. This allows you to qualitatively visualize the pronounced and poorly intracranial sections of the arteries. It is a non-invasive method characterized by painlessness and no side effects.
Treatment methods
Treatment of basilar insufficiency is carried out taking into account the individual characteristics of the patient's body, as well as clinical manifestations. After a comprehensive diagnosis, the doctor can prescribe the right treatment. During treatment, it is important to maintain normal blood pressure.
Next, a special diet is prescribed. It contains a complex of vitamins and minerals. It is especially important to supplement the dietvitamins C and R. Sugar, fatty foods and s alt are excluded. It is strictly forbidden to drink alcohol and smoke. If the patient's condition is satisfactory, non-drug treatment lasts 2-3 months.
The patient is prescribed physical exercises, including for the vestibular apparatus. It is best to do them outdoors. It is also very important to walk every day, go to bed on time, and fully rest. In this case, medication may not be needed.
If the patient's condition is unstable, attacks occur frequently and are of great intensity, medical treatment is required. It must be combined with diet and proper physical activity. In this case, the effectiveness of treatment will be high.
Drugs
To treat basilar insufficiency, the doctor prescribes certain medications. You cannot self-medicate. What works for one patient may not work for another. In this case, an individual approach is above all.
To reduce blood pressure, doctors prescribe ACE inhibitors to patients, for example, it can be Enalapril. Calcium channel blockers may also be required. To do this, you will need to undergo a course of treatment with a drug such as, for example, Felodipine or its analogues. Beta blockers may be prescribed. These include Bisoprolol, Nebivalol.
In some cases, therapy does not give the desired result. Therefore, the patient's condition should be constantly monitored by a doctor. He can write in this casedrug combinations, such as combining ACE inhibitors with diuretics.
Other effective drugs
In addition to pressure stabilizers, the doctor may prescribe some other drugs during the treatment of basilar insufficiency. If the patient has been diagnosed with atherosclerotic lesions of the vessels, heart valve or peripheral arteries, a course of antithrombotic treatment will be required. For this, "Dipyridamole", "Acetylsalicylic acid", "Clopidogrel" are prescribed.
Be sure to prescribe drugs to improve cerebral circulation. This, for example, can be "Cinnarizine", "Piracetam", "Phezam". The last of these drugs is a combination of the first two drugs.
Remedial gymnastics is mandatory. This allows you to strengthen blood vessels, improve blood circulation.
Gymnastics for the vestibular apparatus
Special gymnastics plays an important role in the treatment process. To strengthen the vestibular apparatus, improve the general condition of the patient, you need to do a few simple exercises. They are performed daily and smoothly.
First you need to slowly turn your head from side to side, up and down. The gaze must be moved along with the head, and then fixed at one point.
The hand is placed on the back of the head, and the head is pulled back. In this case, you need to resist with your hand. In this position, the head is held for 3 seconds. The exercise is performed 10 times. The same procedure is performed by placing the fingertips on the forehead, and then alternately on the temples.
A good balance workout is the one-legged stance. First you need to open your eyes, and then close. You need to perform exercises on a soft surface.
It is recommended to get out of bed slowly. First, smoothly turn on one side, and then on the other. The eyes must be opened. This is repeated several times. After that, you can get up.
