One of the most common diseases of the central nervous system is vertebral-basilar insufficiency. This condition is characterized by a number of unpleasant symptoms. To make the treatment as effective as possible, it is necessary to approach the solution of the problem in a comprehensive manner. An experienced doctor will prescribe appropriate therapy after a series of diagnostic procedures. What is this ailment, what are its causes, manifestations and treatment methods will be discussed later.
general description
ICD-10 basilar insufficiency belongs to the 5th class “Vascular diseases of the nervous system” and has the code G45. In this document, the disease is called "Vertebrobasilar Arterial Syndrome".
The disease is a violation of the functions of the brain, which is reversible. This condition is caused by a decrease in blood circulation in a certain area of the brain that feeds on the affected arteries (vertebral and main).
Vertebral-basilar insufficiency is manifested by specific neurological symptoms. This reflects the acute passing brain ischemia 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 the ischemic attack.
The manifestations of this disease are diverse. Several symptoms may appear. The main of them is sometimes impossible to single out. Studying the symptoms of acute basilar insufficiency, doctors identified two categories of manifestations of the disease:
- Paraximal - syndromes occur during the onset of an ischemic attack.
- Permanent - characterized by a prolonged manifestation, observed in the patient between attacks.
In the arteries of the vertebral-basilar system, both ischemic transient attacks and ischemic type strokes of varying degrees of intensity can occur. Including they can be lacunar.
Development reasons
Basilar insufficiency syndrome can develop for various reasons. The main one is various lesions of the vertebral arteries. They have a different nature. Also, pathological changes can be determined in the subclavian and nameless arteries.
Such manifestations are explained by the development of stenosis, which is characterized by an atherosclerotic nature. It is worth noting that quite often vertebro-basilar insufficiency occurs 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, may be osteophytes or spondylosis. Compression caused by such factors can be considered an independent cause of the development of vertebro-basilar 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 decreased blood circulation in this area, in addition to those already mentioned, are:
- Hernia of the spinal disc of the cervical spine.
- Muscle spasm 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 vertebro-basilar insufficiency can manifest itself 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 site affected by ischemia and its localization are determined.
Blood supply to the brain stem and cerebellum may vary slightly in different people. Therefore, the described classical neurological manifestations in reality in their pure form almost never occur. In repeated episodes, the side of sensory and motor abnormalities and disorders may change.
One of the 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 impaired or muscle tone may decrease asymmetrically.
Sensitive disorders are often manifested by full or partial anesthesia in the limb, in half of the body. Paresthesia may appear. 25% of patients have a superficial or deep violation of sensitivity.
It should be noted that according to clinical manifestations, it is not always possible to determine the involvement in the pathological processes of certain sections of the blood supply to the vertebral, carotid arteries. Therefore, the diagnosis can not do without methods of neuroimaging.
Visual disturbances, dizziness
Among the symptoms of basilar insufficiency, one of the most common manifestations is visual impairment. Such a deviation may occur in the loss of fields. Photopsies may appear.
When the circulatory system of the brain stem is affected, disturbances appear in the nerves of the cranium. Oculomotor disorders may occur. This may be, for example, strabismus, vertical distance of the eyeballs, etc. This category of disorders also includes peripheral paresis of the facial muscles and bulbar syndrome.
The listed manifestations can be observed in different combinations. Less commonly, only one syndrome appears. Lesions can be caused by a combination of circulatory disorders in the vertebral and carotid arteries.
Another common symptom of vertebro-basilar insufficiency is the occurrence of dizziness. This condition can last several minutes, but sometimes it reaches several hours. This is due to the morphological and functional features of the human blood supply system, high sensitivity to ischemia.
Dizziness can be of different types. Sometimes a systemic violation of the vestibular apparatus appears. But there is 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. In this case, nausea, and sometimes vomiting, often occurs. The patient has hyperhidrosis, increased heart rate, a change in blood pressure.
Over time, the intensity of discomfort decreases. But focal symptoms, for example, ataxia, may appear. They become more pronounced, acquire a persistent, permanent character.
Hearing impairment
Studying the symptoms and treatment of vertebro-basilar insufficiency, it is worth noting another frequent manifestation of pathology. These are hearing impairments. It can noticeably decrease, noise appears in the ears. A feeling of congestion may also occur. Similar symptoms most often occur with ischemia of the zone of the lower anterior cerebellar artery. It supplies blood to the dorsolateral regions of the brain, as well as the leg of the cerebellum. This artery also feeds the inner ear, the cochlear nerve.
Auditory and vestibular disorders, manifested systemically, are often accompanied by other neurological manifestations. This indicates a pathology of nutrition of the cerebellum and the brain stem.
Much less often, the patient has 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 arises due to a decrease in patency of the auditory artery, which is the terminal branch of the lower anterior cerebellar artery. There are no anastomoses.
Such an isolated violation is very rare. A comprehensive diagnosis is required, since such a manifestation sometimes indicates the beginning of the development of an extensive stroke, which is accompanied by a significant deficit of the neurological type.
Diagnostics
To prescribe an effective treatment regimen for basilar insufficiency, the doctor prescribes a comprehensive examination. Today, one of the best neuroimaging techniques is MRI. Using this procedure, it is possible to identify even minor foci of pathology.
If you want 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 study the vascular bed using magnetic resonance angiography. However, the X-ray contrast type angiography surpasses this procedure in terms of informativeness.
If the patient has symptoms of damage to the main artery, only cerebral selective angiography will be informative. If the narrowing of the walls and a decrease in the patency of the vessels is caused by atherosclerosis, especially in the distal vertebral regions, digital angiography of the arteries is a rather informative technique. An intravenous analogous 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.
During the behavior of ultrasound, today they use a Doppler setup and a triplex scanner. This allows you to qualitatively visualize the expressed and poorly intracranial sections of the arteries. This is a non-invasive method, characterized by painlessness and the absence of 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 correct 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 diet with vitamins C and R. Sugar, fatty foods and salt 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 exercise, including for the vestibular apparatus. It is best to spend them outdoors. It is also very important to walk every day, go to bed in time, have a good rest. In this case, medical treatment may not be required.
If the patient's condition is unstable, seizures often occur and have a high intensity, drug treatment is required. It must be combined with diet and proper physical activity. In this case, the effectiveness of the treatment will be high.
Medications
For the treatment of basilar insufficiency, the doctor prescribes certain medications. You can not self-medicate. What is appropriate for one patient may not be acceptable for another. An individual approach in this case is above all.
To reduce pressure, doctors prescribe ACE inhibitors to patients, for example, it may be the drug Enalapril. Calcium channel blockers may also be required. To do this, you will need to undergo a course of treatment with such a drug as, for example, “Felodipine” or its analogues. Beta blockers may be prescribed. These include Bisoprolol, Nebivolol.
In some cases, therapy does not give the desired result. Therefore, the patient's condition should be constantly monitored by a doctor. In this case, he can prescribe combinations of drugs, for example, 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 a patient has been diagnosed with atherosclerotic lesions of blood vessels, a heart valve, or peripheral arteries, a course of antithrombotic treatment will be required. For this, "Dipyridamole", "Acetylsalicylic acid", "Clopidogrel" are prescribed.
Necessarily prescribed drugs to improve cerebral circulation. This, for example, may be Cinnarizine, Piracetam, and Fezam. The last of these drugs is a combination of the first two medicines.
Physiotherapy exercises are definitely prescribed. This allows you to strengthen blood vessels, improve blood circulation.
Gymnastics for the vestibular apparatus
An important role in the treatment process is played by special gymnastics. 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, down and up. The gaze needs to be moved with the head, and then fixed at one point.
The hand is placed on the back of the head, and the head is laid back. At the same time, you need to resist with your hand. In this position, the head is held for 3 seconds. Exercise is performed 10 times. The same procedure is performed by putting the fingertips on the forehead, and then alternately on the whiskey.
A good balance training is to stand on one leg. 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. You need to open your eyes. This is repeated several times. After that you can get up.