In the article, we consider that this is a diagnosis of VBI and the consequences of this pathology.
The human brain is supplied with blood according to a certain pattern. The vertebrates are separated from the subclavian arteries located in the upper part of the sternum, which then enter the openings located in the transverse processes of the cervical spine and enter the skull. At the base of the cranium, they are included in the basilar artery, passing in the stem part of the brain, cerebellar and occipital region of the cerebral hemispheres. Subsequently, the basilar artery is divided into vessels, which are responsible for supplying blood to a certain hemisphere of the brain.
If the blood filling in the arteries supplying the brain is reduced, including due to osteochondrosis of the cervical spine, the so-called vertebro-basilar insufficiency or VBI develops. Since the blood supply to the brain becomes insufficient, against the background of the diagnosis of VBI there is a deficiency of nutrients and oxygen, which disrupts the proper functioning of the organ, characteristic signs of the disease appear.
Causes
There are many reasons for the development of a diagnosis of VBI. Young and middle-aged patients suffer from the disease due to external compression of the vertebral arteries due to their compression by bone growths or osteophytes, as well as against a background of disk hernia and spasms of the neck muscles.
In addition, vertebro-basilar insufficiency can occur due to a deformation process in the canal of the spinal artery against the background of subluxation of the cervical vertebrae. In some cases, the development of VBI is caused by pathological abnormalities such as vertebral artery hypoplasia, Kimmerley syndrome, and the presence of an additional cervical rib.
Pain spasm
Painful spasm of the vertebral arteries also plays a significant role in the development of the diagnosis of VBI. In the area of the arteries of the spine are small branches that originate from the autonomic nerves that form the plexus. If the patient has a history of osteochondrosis, pain in the neck can provoke a pathological process in the form of VBI. In addition, due to the pain syndrome, irritation of the vertebral structures and hyperactivation of the sympathetic nerves occurs. As a result, the innervation of the vertebral arteries occurs, accompanied by a prolonged and sustained spasm.
Diagnosis of VBI in a child and elderly
In childhood, the onset of the disease can be due to the anatomical features of the structure of the spine, is associated with a family history, or received as a result of a birth injury and head injury in infancy.
In very many children in neurology, a diagnosis of VBI is identified.
In old age, vertebro-basilar insufficiency may be the result of atherosclerotic changes in the arteries of the spine. In this case, atherosclerotic plaques form in the lumen of large vessels. Plaque contains a large amount of cholesterol, which clogs the lumen of the artery and disrupts the blood supply to the brain.
In some cases, thrombi appear in the areas of plaque localization, which block the arterial lumen even more. Blood supply may also be impaired as a result of blockage of an artery by a blood clot formed in another area of the body and passed through the bloodstream to the pool of vertebral vessels. In this case, we are talking about thromboembolism.
The diagnosis of VBI in neurology is made quite often.
The syndrome can be caused by incorrect medical procedures, as well as manual therapy and trauma to the vertebral region. Another risk factor for the development of the syndrome is stenosis of the subclavian artery, which provides blood supply to the upper limbs.
Against the background of fibromuscular type dysplasia, numerous medium-sized arterial stenoses form. In some cases, spinal arteries are also involved in the pathological process, which leads to a diagnosis of VBI.
Symptoms
Manifestations of vertebro-basilar insufficiency can be quite diverse. Neurological signs of pathology may include visual, vestibular and conduction or sensory disturbances. In addition, with a diagnosis of VBI in neurology, a dysfunctional disorder of nerves located in the skull is observed.
From the side of the musculoskeletal system, VBN is manifested by a violation of coordination, as well as by central paresis. As a rule, the syndrome is characterized by a combination of dynamic ataxia and intentional tremor in the limbs, as well as a decreased muscle tone of an asymmetric look.
The severity and combination of various symptoms of VBI is due to the vastness of ischemic lesions and their localization, as well as the possibility of blood circulation of the collateral type.
Sensitive disorders are often accompanied by hypo-or anesthesia in one half of the trunk or limb, as well as multiple paresthesias.
In every fourth patient with a diagnosis of VBI, the symptoms may vary, but surface and deep sensitivity disorders almost always occur, which is explained by the disruption of the ventrolateral thalamus in the areas of blood supply to the external villous artery in its posterior part. It is far from always possible to detect blood supply disturbances in the area of the spinal arteries, therefore quite often it is necessary to additionally use neuroimaging methods.
Visual disturbances in VBI are accompanied by symptoms such as scotoma, cortical blindness, homonymous hemianopsia, and also photopsy.
If the brain stem has also been affected, disturbances in the functioning of the cranial nerves occur. As a result, there is paresis of the facial nerve, bulbar syndrome, various disorders of eye movements.
The listed symptoms, as a rule, manifest themselves in the aggregate, however, in exceptional cases, isolated symptoms occur, which is explained by the reversible type of ischemia in the system of vertebral-basilar vessels.
Quite often, pathologies of the spinal arteries associated with a compression crisis in the cerebro-vascular system are also associated with radiculitis in the neck. Signs of this disease are painful palpation and limited cervical mobility. The severity of pain is enhanced by turning and tilting the head.
Dizziness and autonomic disorder
Paroxysmal dizziness may also indicate a problem with the blood supply to the brain. This phenomenon is due to the high sensitivity of the vestibular apparatus to ischemic symptoms. Dizziness can be mixed or systematic, while the movement is rectilinear, and the patient feels it, as the rotation of the objects surrounding it, and his own body.
Another characteristic symptom of VBI is distinguished - disorders of the autonomic system, accompanied by nausea and vomiting, impaired heart rate, increased blood pressure and severe hyperhidrosis.
In conjunction with other symptoms, a violation of auditory perception can also indicate a VBI. This can be a decrease in the quality of perception by ear, or congestion, tinnitus. Typically, this symptom indicates ischemia in the lower anterior part of the cerebellum.
It must be understood that the above symptoms are also characteristic of other pathologies of the brain and the cardiovascular system, therefore it is important to conduct a full examination and differential diagnosis to clarify the diagnosis.
Diagnostics
The most important step in diagnosing vertebro-basilar insufficiency is to identify the cause that provoked the development of the pathological process. For this purpose, a detailed neurological examination is carried out, aimed at differentiating the disease from similar pathologies. So, to identify VBI, the following instrumental studies are carried out:
1. Doppler ultrasound allows you to assess the state of blood supply to the vessels of the brain and major arteries. This method combines duplex scanning and dopplerography, gives an idea of the condition of the vertebral arteries.
2. Rheoencephalography, together with infrared thermography, also allows you to appreciate the state of the arteries of the brain and spine, but are less informative than the previous method.
3. Computer and magnetic resonance imaging makes it possible to detect the presence of intervertebral hernias, as well as other pathological processes in the spinal column, which can lead to the development of VBI.
4. X-ray examination evaluates the condition of the vertebral cervical spine.
5. Functional tests performed with extension and flexion, allow to determine the presence of spondylolisthesis.
In some cases, such as acoustic stimulation, vestibulological research, audiometry, etc. can become no less effective diagnostic methods. Laboratory methods for the diagnosis of VBI is a blood test for biochemistry and coagulation.
What is the treatment for VBI against cervical osteochondrosis?
Drug treatment
The choice of therapeutic regimen directly depends on the degree and nature of vascular damage. Conservative treatment of vertebro-basilar insufficiency includes the following drugs:
1. Antiplatelet agents. The action of this group of drugs is aimed at reducing blood coagulation. The use of antiplatelet agents is due to the need to prevent the formation of blood clots. "Aspirin" is the most common blood thinning drug. It should be borne in mind that acetylsalicylic acid negatively affects the condition of the gastrointestinal tract and can cause hemorrhagic syndrome. It is contraindicated to take with existing gastrointestinal pathologies, and it is also not recommended to drink tablets on an empty stomach.
2. Drugs that dilate blood vessels. They are necessary to prevent obstruction of blood vessels. As a rule, course treatment in spring and autumn is required. Dosage should be increased from the minimum to the optimal therapeutic amount. If monotherapy does not give positive dynamics in the patient’s condition, it is recommended that several similar drugs be taken simultaneously.
3. Metabolic and nootropic drugs. The most commonly prescribed are Piracetam, Actovegin, Glycine, Nicergoline, Semax, etc. These drugs are used to stimulate the brain, reduced on the background of VBI with cervical osteochondrosis.
Treatment is not limited to this.
In addition to these drugs, vertebro-basilar insufficiency can be treated with drugs that normalize blood pressure. On an individual basis, painkillers, antidepressants, sleeping pills and sedatives, as well as antiemetics and medications that stop dizziness, can be prescribed as additional drugs. These drugs help to eliminate symptoms in the diagnosis of VBI in neurology.
Treatment should be comprehensive and timely.
Other treatments
If the course of vertebro-basilar insufficiency is characterized as severe, surgery may be prescribed. The purpose of the operation is to eliminate circulatory disorders caused by VBI. This is done by expanding the basilar and vertebral arteries. In addition, the operation allows you to eliminate compression of the intervertebral discs, relieve stress and stenosis from them. Surgery may include manipulations such as endarterectomy and microdisectomy.
Neurologists believe that treatment of vertebro-basilar insufficiency should take place in a complex. For this reason, in addition to drug treatment, patients with this diagnosis are prescribed special therapeutic exercises, as well as physiotherapeutic procedures.
In addition, treatment of VBI is carried out using the following methods:
1. Therapeutic massage aimed at improving blood circulation.
2. Visit to the chiropractor.
3. Acupuncture and reflexology, eliminating muscle spasms.
4. Hirudotherapy. Almost all vascular diseases can be eliminated by leeches as an additional treatment method.
5. Magnetotherapy. Favorably affects the circulatory system.
6. Wearing a special corrective corset on the neck.
Timely and correct treatment of VBI against the background of cervical osteochondrosis can completely eliminate the disease. Otherwise, the risk of a pathology becoming chronic increases, as well as a significant deterioration in the patient's quality of life.
Forecast
The prognosis for vertebro-basilar insufficiency is made on the basis of the severity and nature of the disease of the cardiovascular system that caused this syndrome, as well as the degree of damage to the arteries and the possibility of establishing bypass blood supply to the brain.
If the arteries show a tendency to narrowing more, and the correct therapy was not carried out in a timely manner, the risk of developing irreversible consequences and complications increases. Such patients are prone to stroke, as well as encephalopathy of the discirculatory type against the background of a stable neurological deficit.
A favorable prognosis for VBI is possible only in the case of a satisfactory assessment of the state of the vessels of the brain, as well as with the right treatment against the background of a mild course of pathology.
Prevention
Mandatory preventive measures for VBI are:
1. Quitting smoking, drinking alcohol and drugs.
2. Regular monitoring of blood pressure.
3. Compliance with a special diet. The limit is subject to pastries, salt, spicy and spicy foods, marinades and canned goods. Recommended products for VBI are seafood, fruits and vegetables, low-fat dairy products.
4. The presence of moderate physical activity of medium intensity.
In some cases, the above measures are enough to stop the disease, even in the absence of drug and physiotherapy support.
If the disease was detected at the initial stage of its development, treatment is carried out on an outpatient basis. With a later detection of the pathological process, hospitalization is recommended. This is to prevent the development of a stroke.
We examined the symptoms and treatment of VBI.