If an attack of vertebro basilar insufficiency. Vertebro-basilar insufficiency: occurrence, signs, diagnosis, comprehensive treatment

Content

Unsteady gait frequent dizziness- a signal of circulatory disturbances in the arteries supplying the brain. Such signs mean the development of vertebrobasilar syndrome. In the absence of timely treatment, pathologies of the arterial system impair brain function. This can lead to stroke and death.

What is vertebrobasilar arterial system syndrome?

Several arteries supplying the brain pass through the spine. The main one is the basilar one and the network of vertebral (vertebral) vessels. When arterial blood flow is disrupted due to various reasons, this leads to the following problems:

• the supply of oxygen and glucose to the brain is limited;
• its cells do not have enough nutrition;
• there is a metabolic disorder;
• hypoxia causes ischemic processes;
• Central nervous system (CNS) disorders occur.

The syndrome of the vertebrobasilar arterial system according to the international classification of diseases ICD-10 has code G 45.0. This condition is characterized by atrophic brain lesions. Impaired blood supply causes damage to the cerebellum, brainstem, and occipital lobes. To cope with the disease, you need to identify the reason why basilar artery syndrome developed and eliminate it. Pathology may have other names:

• vertebrobasilar syndrome;
• vertebrobasilar insufficiency(VBN);
• vestibular insufficiency.

Causes

The appearance of vertebrobasilar arterial system syndrome is facilitated by spinal injuries and vascular dysfunction. Diseases can be provoking factors for the development of pathology. Among the reasons that often lead to the occurrence of vertebrobasilar syndrome are:

• genetic predisposition;
• spinal injuries in the cervical region;
• congenital hypoplasia (underdevelopment) of the vertebral arteries;
• fibromuscular dysplasia (Kimmerly anomaly);
• arteritis (inflammation of arterial walls);
• osteochondrosis.

The appearance of vertebrobasilar pathology is facilitated by dysfunctions of the arterial system. These include the following reasons:

• atherosclerosis, causing deterioration of vascular patency;
• spondylolisthesis (displacement of the vertebrae forward or backward);
• dissection of the vertebrobasilar vessels;
• thrombosis of the vertebral, basilar artery;
• diabetes mellitus, accompanied by damage to small cerebral vessels;
• spondylosis (deformation of the vertebrae due to the proliferation of bone tissue);
• compression of blood vessels by a hernia of the cervical spine.

Provoking factors for vestibular insufficiency of the arterial system can be:

• antiphospholipid syndrome, which promotes thrombosis;
• arterial hypertension;
• active head turns;
• congenital pathological changes vessels;
• birth injuries;
• squeezing of blood vessels during prolonged tilting of the head;
• blood pathologies;
• keeping the head in a fixed position for a long time;
• diseases of the cardiovascular system.

Symptoms

With insufficiency of the vertebrobasilar arterial system, two forms of signs of pathology are often observed. They depend on the nature of the cerebral circulatory disorder. Doctors identify the following types of symptoms of the disease:

• Temporary - lasts several hours, occurs during transient ischemic attacks. Cause short-term circulatory disorders, lasting up to a day.
• Constant – characterized by an increase, deterioration of the condition, often leading to acute form which can result in a stroke.

Vertebro-basilar syndrome is sometimes accompanied by the following symptoms that last a long time:

• dull, throbbing pain in the occipital region;
• change in coordination of movements;
• dizziness;
• fainting;
• the appearance of tinnitus;
• memory impairment;
• absent-mindedness;
• imbalance;
• loss of visual fields;
• the appearance of “flies” before the eyes;
• brokenness;
• prostration;
• sore throat;
• hoarseness of voice;
• tachycardia;
• nausea;
• irritability;
• weakness;
• change of mood;
• feeling of heat.

Chronic vertebrobasilar insufficiency

If left untreated, symptoms of arterial system pathology become permanent. They can intensify and lead to an acute form of vertebrobasilar syndrome. With the development of the chronic stage, the patient sometimes complains of the following signs of illness:

• disturbances in concentration;
• vision pathologies – blurred vision, flickering;
• fatigue;
• rapid heartbeat;
• hearing impairment;
• increased sweating;
• speech disorders;
• the appearance of swallowing problems;
• feeling of a lump in the throat;
• ear pain;
• vomiting.

Acute

Vertebrobasilar insufficiency can occur suddenly. Often its cause is a hypertensive crisis. The acute form of the pathology lasts from several hours to a day. Vertebro-basilar syndrome in this situation is accompanied by the following symptoms:

• dizziness;
• hallucinations;
• temporary loss of vision;
• unpleasant sensations in the cervical spine;
• headaches;
• movement disorders;
• loss of consciousness;
• restriction of body mobility.

Vertebrobasilar crisis can lead to ischemic stroke. In the acute form of the syndrome, the following signs of pathology cannot be ruled out:

• diplopia (double vision);
• numbness of the mouth area;
• speech disorders;
• weakness in the legs;
• sudden fall;
• pressing pain in the back of the head;
• disorientation in space and time;
• involuntary trembling of the torso and limbs;
• decreased performance.

Vertebro-basilar insufficiency in children

The syndrome can develop in patients regardless of age. Dysfunction of the arterial system that supplies the brain is observed in children starting from three years of age. Often the cause of vertebrobasilar syndrome is a congenital anomaly of vascular development. Risk factors include:

• spinal injuries caused by sports activities;
• damage resulting from falls, transport emergencies;
• sitting for a long time in an uncomfortable position;
• birth injuries of the spine;
• perinatal encephalopathy.

If a child has damage to the basilar artery or vertebral vessels supplying the brain, the following signs of vertebrobasilar syndrome are often observed:

• poor posture;
• increased drowsiness;
• chronic fatigue;
• dizziness;
• frequent bouts of crying;
• intolerance to stuffiness;
• fatigue when solving mental problems;
• poor tolerance of emotional stress;
• pain in the back of the head;
• sleep disturbance;
• excitability;
• nosebleeds;
• weather dependence;
• fainting;
• vomit.

Complications and consequences

When signs of vertebro- basilar insufficiency, you need to contact specialists for diagnosis and treatment. In case of circulatory disorders in the arterial system supplying the brain, the occurrence of severe consequences. The patient may develop the following complications:

• constant feeling of discomfort in the neck;
• circulatory disorders in all organs;
• decreased performance.

The patient's inattention to his health, lack of treatment when signs of vertebrobasilar syndrome occur, can result in serious consequences:

• the occurrence of dyscirculatory encephalopathy (progressive brain damage);
• the emergence of a risk of cardiovascular diseases;
• development of cerebral ischemia, stroke;
• the onset of death.

Diagnostics

Vertebrobasilar insufficiency has symptoms similar to other ailments, which complicates diagnosis. Doctors are faced with the task of differentiating the disease. A clinical picture identical to the syndrome can be observed in the following pathologies:

• multiple sclerosis;
• vestibular neuronitis (pathology of the vestibular apparatus);
• acute labyrinthitis (damage to nerve receptors inner ear);
• Meniere's disease (increased volume of labyrinthine fluid in the inner ear);
• neuroma (benign tumor) of the auditory nerve;
• mental disorders.

To prescribe treatment, it is necessary to establish the cause of vertebrobasilar insufficiency. For this, the following diagnostic methods are used:

• biochemical blood test;
• Doppler ultrasound of the arteries of the vertebrobasilar system;
• radiography of the spine;
• magnetic resonance imaging (MRI) - to study changes in the spine;
• electrocardiogram;
• angiography - examination of blood vessels with the introduction of a contrast agent;
• computed tomography (CT) - to identify a hernia;
• rheoencephalography - study of the blood supply to the brain.

The following research methods help to make a correct diagnosis and differentiate the disease from other pathologies:

• infrared thermography – assesses the patient’s condition based on thermal fields;
• Vascular auscultation is a physical method of listening to arteries;
• functional tests with extension, flexion - reveal spondylolisthesis (vertebral displacement);
• duplex scanning of cerebral vessels - studies the bed of blood vessels, the condition of the walls;
• neuropsychological testing – identifies cognitive (mental) brain functions;
• examination of the hearing organs.

Treatment of vertebrobasilar syndrome

When diagnosing vestibular insufficiency at an early stage, doctors provide outpatient treatment. Lifestyle changes are mandatory. The patient is required to perform the following activities:

• following a special diet that limits salt, fried, and fatty foods;
• regular measurement of blood pressure (BP);
• giving up alcohol and smoking;
• maintaining physical activity.

Treatment of vertebrobasilar syndrome includes a set of measures, which include the use of medications. Treatment tactics are selected individually. Doctors prescribe to patients:

• vasodilators;
• antiplatelet agents that reduce the risk of blood clots;
• nootropic drugs that improve brain function;
• blood pressure stabilizing agents;
• sleeping pills;
• painkillers;
• antidepressants;
• antiemetics;
• anti-dizziness medications.

In addition to drug therapy, for basilar artery syndrome, the following treatment methods are used to help restore blood circulation in the vertebrobasilar system:

• wearing a neck brace;
• physiotherapy – magnetic therapy, laser treatment, ultraphonophoresis;
• massage;
• manual therapy;
• treatment with leeches;
• acupuncture.

In the absence of treatment results, if it is necessary to improve blood flow in the arterial system, the patient is recommended to undergo surgery. The following surgical techniques are used:

• Angioplasty is the insertion of a special stent into a vessel to maintain normal arterial circulation.
• Endarterectomy – removal of atherosclerotic plaques.
• Microdiscectomy – removal of a herniated intervertebral disc.

Gymnastics

One of the ways to improve the condition of vertebrobasilar syndrome is physiotherapy. Regular performance of gymnastics exercises removes muscle spasms, activates blood circulation, strengthens the spine, and improves posture. During classes, it is recommended to adhere to the following rules:

• perform all movements smoothly;
• It is better to do gymnastics in the morning;
• perform the complex daily, without breaks;
• breathe through the nose, evenly, calmly;
• do each exercise 10 times;
• take a shower after class.

The complex is performed in the starting position (IP) standing. It includes the following exercises:

1. Stand up straight, tilt your head forward, touch your chin to your chest. Hold for 5 seconds, return to IP.
2. Tilt your head to the side and touch your right shoulder with your ear. Hold for 5-8 seconds, return to IP, repeat in the other direction.
3. Rotate your head alternately clockwise and in the opposite direction.
4. Pull the top of your head up, fix the position for 10 seconds, relax.
5. Raise your arms up to your sides and join your palms. Hold for 10 seconds, return to IP.

Medications

When treating disorders of the vertebrobasilar system, one cannot do without the use of medications. They are used in the form of tablets, drops for oral administration, and injections. Doctors prescribe the following groups of medications:

• nootropic drugs - to improve brain function - Glycine, Semax, Piracetam, Cerebrolysin;
• antiplatelet agents that prevent thrombosis - Aspirin, Dipyridamole, Clopidogrel, Aggregal, Ticlopidine;
• vasodilators - Nicotinic acid, Cavinton.

When treating insufficiency of the vertebrobasilar system, much attention is paid to eliminating the causes of the pathology. To exclude hypertensive crisis To lower blood pressure, the following drugs are prescribed:

• diuretics – Theobromine, Indapamide;
• sartans - Telmisartan, Valsartan;
• beta-blockers – Metoprolol, Nebivolol;
• calcium channel antagonists – Amlodipine. Verapamil;
• ACE inhibitors – Dapril, Lisinopril.

Symptomatic therapy plays an important role in vertebrobasilar crisis. Patients are prescribed the following medications:

• antispasmodics – Papaverine hydrochloride, Baclofen, Troxerutin;
• for dizziness - Betaserc, Trental;
• painkillers – Baralgin, Ketanol;
• for nausea – Diacabr, Motilium;
• sedatives - Novopassit, Afobazol;
• antidepressants – Phenibut, Avifen.

Injections help dilate blood vessels in the brain Nicotinic acid. According to the instructions, the drug has the following characteristics:

• Indications: ischemic cerebral circulatory disorders, atherosclerosis.
• Dosage – 10 mg in the morning and evening, course of therapy – 2 weeks.
• Side effects - decreased blood pressure, redness of the face, headache, allergies.
• Contraindications – exacerbation of ulcers, diabetes mellitus, gout, hepatitis, liver cirrhosis, pregnancy.

A find in the treatment of vestibular insufficiency is the drug Papaverine hydrochloride. The product is distinguished by the following qualities:

• Action – vasodilator, diuretic, antispasmodic.
• Release form: tablets, injection solution, rectal suppositories.
• Indications: hypertensive crisis, vasospasm.
• Oral dosage: 50 mg up to five times daily.
• Side effects - drowsiness, nausea, decreased blood pressure, heart rhythm disturbances.
• Contraindications: intolerance to papaverine, children under 6 months of age, glaucoma, liver failure.

To improve microcirculation in the vessels of the brain and metabolic processes in its tissues, the nootropic drug Piracetam is prescribed. The instructions for the drug stipulate the following points:

• Indications: dizziness, cerebrovascular accident.
• Dosage – tablet three times a day.
• Side effects - excitability, irritability, drowsiness.
• contraindications – children under one year of age, pregnancy, lactation period, renal failure, hypersensitivity to the drug.

Treatment with folk remedies

For pathologies of the vertebrobasilar system, recipes can be used traditional healers only in consultation with a doctor. Such drugs should become an addition to medical treatment tactics. To prevent blood clots, it is useful to consume foods containing vitamin C, which thins the blood. These include:

• sea ​​​​buckthorn;
• viburnum;
• cranberry;
• currant;
• citrus;
• kiwi;
• bell pepper;
• sauerkraut.

1. Peel three heads of garlic.
2. Pass them through a meat grinder.
3. Place in a jar and leave in a cool, dark place.
4. After three days, squeeze the mixture through several layers of gauze.
5. Add equal parts honey and lemon juice.

To reduce pressure when arterial hypertension It is useful to drink 100 ml of a product containing natural ingredients three times a day. The course of treatment is repeated 3 times, includes a weekly dose and the same break. The recipe requires:

1. Place 40 g of corn silk in a container.
2. Add 20 grams of lemon balm.
3. Pour in the juice of one lemon.
4. Add a liter of boiling water.
5. Leave for an hour.

To dilate blood vessels, it is useful to drink hawthorn infusion - 20 g of fruit per glass of boiling water. The composition should be kept for 15 minutes in a water bath, leave for half an hour, take a spoon three times a day, before meals. Infusion of medicinal herbs promotes vasodilation. Pour two cups of boiling water over a spoonful of the mixture and cover for 30 minutes. One half should be drunk in the morning, and the second half in the evening, taken half an hour before meals. The treatment fee includes equal parts of the following components:

• birch buds;
• immortelle;
• yarrow;
• St. John's wort;
• chamomile flowers.

To reduce blood clotting in vertebrobasilar syndrome, horse chestnut tincture is used. Take it one teaspoon in the morning and evening, half an hour before meals. To prepare the medicine you will need:

1. Take 500 g of horse chestnut seeds.
2. Grind to a powder.
3. Pour in a liter of boiled water.
4. Leave for a week in a dark place.
5. Strain.

Forecast

If the patient has been correctly diagnosed and started timely treatment, you can achieve an improvement in the condition and eliminate the signs of vertebrobasilar syndrome. It is important that the patient follows all the doctor’s orders. With late diagnosis and lack of treatment, the development of a chronic form of pathology cannot be ruled out. This can lead to the following consequences:

• deterioration of health;
• frequent ischemic attacks;
• development of dyscirculatory encephalopathy;
• the occurrence of a stroke;
• in severe cases - death.

Prevention

To prevent the occurrence of vertebrobasilar syndrome, you must follow some rules. It is important to seek help from a doctor when symptoms of the disease appear. Prevention of lesions arterial vessels that nourish the brain includes the following activities:

• following a diet - excluding fatty, smoked, fried foods that contribute to the formation of blood clots;
• performing therapeutic exercises;
• to give up smoking;
• avoiding alcohol consumption;
• reducing salt intake.

To slow the progression of the syndrome, it is important to practice moderate physical exercise. Prevention of vertebrobasilar insufficiency involves the following measures:

• constant monitoring of blood pressure;
• stabilization of its indicators with medicines;
• regular walks in nature;
• avoidance of stressful situations;
• exclusion of injury during sports;
• creating comfortable conditions for sleep;
• observation by a doctor, periodic examinations;
• avoiding uncomfortable positions causing disorder blood supply to the brain.

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Vertebro-basilar insufficiency(synonyms Vertebrobasilar insufficiency and VBI) - a reversible disorder of brain function caused by a decrease in blood supply to the area supplied by the vertebral and basilar arteries.

Synonymous with vertebrobasilar arterial system syndrome, this is the official name for vertebrobasilar insufficiency.

Due to the variability of the manifestations of vertebrobasilar insufficiency, the abundance of subjective symptoms, the difficulty of instrumental and laboratory diagnosis of vertebrobasilar insufficiency and the fact that the clinical picture resembles a number of other pathological conditions - in clinical practice, overdiagnosis of VBI often occurs when the diagnosis is established without compelling evidence. then the reasons.

Causes of VBI

The causes of vertebrobasilar insufficiency or VBI are currently considered:

1. Stenosing lesion great vessels, Firstly:

Extracranial region of vertebrates
subclavian arteries
innominate arteries

In most cases, obstruction of the patency of these arteries is caused by atherosclerotic lesions, and the most vulnerable are:

The first segment is from the beginning of the artery to its entrance into the bone canal of the transverse processes of the C5 and C6 vertebrae
fourth segment - a fragment of an artery from the site of perforation of the dura mater to the confluence with another vertebral artery at the border between the pons and medulla oblongata, near the area of ​​formation of the main artery

Frequent damage to these areas is due to local features of the geometry of the vessels, which predispose to the emergence of areas of turbulent blood flow and damage to the endothelium.

2. Congenital features of the structure of the vascular bed:

Anomalous origin of the vertebral arteries
hypoplasia/aplasia of one of the vertebral arteries
pathological tortuosity of the vertebral or basilar arteries
insufficient development of anastomoses at the base of the brain, primarily the arteries of the circle of Willis, limiting the possibilities of collateral blood supply in conditions of damage to the main artery

3. Microangiopathy against the background of arterial hypertension, diabetes mellitus can cause the occurrence of VBI (damage to small cerebral arteries).

4. Compression of the vertebral arteries by pathologically altered cervical vertebrae: with spondylosis, spondylolisthesis, large-sized osteophytes (in recent years the role of compression on the vertebral arteries has been reconsidered as an important cause of VBI, although in some cases there is quite pronounced compression of the artery when turning the head, which, in addition to a decrease in blood flow through the vessel, can also be accompanied by arterio-arterial embolisms)

5. Extravasal compression of the subclavian artery by the hypertrophied scalene muscle, hyperplastic transverse processes of the cervical vertebrae.

6. Acute injury to the cervical spine:

Transport (whiplash)
Iatrogenic due to inadequate manipulations of manual therapy
improper performance of gymnastic exercises

7. Inflammatory lesions of the vascular wall: Takayasu’s disease and other arteritis. Women of childbearing age are the most vulnerable. Against the background of an existing defective vessel wall with thinning of the media and thickened, compacted intima, its dissection is possible even in conditions of minor trauma.

8. Antiphospholipid syndrome: may be the cause of a combination of impaired patency of extra- and intracranial arteries and increased thrombus formation in individuals young.

Additional factors contributing to cerebral ischmia in vertebrobasilar insufficiency (VBI):

Changes in the rheological properties of blood and microcirculation disorders with increased thrombosis
cardiogenic embolism (the frequency of which reaches 25% according to T.Glass et al., (2002)
small arterio-arterial embolisms, the source of which is a loose parietal thrombus
complete occlusion of the lumen of the vessel as a consequence of atherosclerotic stenosis of the vertebral artery with the formation of a parietal thrombus

Increasing thrombosis of the vertebral and/or basilar artery at a certain stage of its development can manifest itself as a clinical picture of transient ischemic attacks in the vertebrobasilar system. The likelihood of thrombosis increases in areas of arterial trauma, for example, when the transverse processes CVI-CII pass through the bone canal. Probably, the provoking moment for the development of vertebral artery thrombosis in some cases can be a long stay in an uncomfortable position with a forced position of the head.

Data from sectional and neuroimaging research methods (primarily MRI) reveal the following changes in brain tissue (brain stem, pons, cerebellum, occipital lobe cortex) in patients with VBI:

Lacunar infarctions of varying duration
signs of neuronal death and proliferation of glial elements
atrophic changes cerebral cortex

These data, confirming the existence of an organic substrate of the disease in patients with VBN, indicate the need for a thorough search for the cause of the disease in each specific case.

Symptoms of vertebrobasilar insufficiency

The diagnosis of circulatory failure in the Air Force is based on a characteristic symptom complex that combines several groups of clinical symptoms:

Visual disorders
oculomotor disorders (and symptoms of dysfunction of other cranial nerves)
violations of statics and coordination of movements
vestibular (cochleovestibular) disorders
pharyngeal and laryngeal symptoms
headache
asthenic syndrome
vegetative-vascular dystonia
conduction symptoms (pyramidal, sensitive)

It is this symptom complex that occurs in most patients with circulatory insufficiency in the vertebrobasilar region. In this case, a presumptive diagnosis is determined by the presence of at least two of these symptoms. They are usually short-term and often go away on their own, although they are a sign of trouble in this system and require clinical and instrumental examination. A thorough medical history is especially necessary to clarify the circumstances of the occurrence of certain symptoms.

At the core clinical manifestations VBN is a combination:

Characteristic complaints of the patient
objectively detectable neurological symptoms indicating the involvement of structures supplied by the vertebrobasilar system.

The core of the clinical picture of vertebrobasilar insufficiency is the development of neurological symptoms, reflecting transient acute cerebral ischemia in the areas of vascularization of the peripheral branches of the vertebral and basilar arteries. At the same time, some pathological changes can be detected in patients even after the completion of an ischemic attack. The same patient with VBI usually combines several clinical symptoms and syndromes, among which it is not always easy to identify the leading one.

Conventionally, all symptoms of VBI can be divided into:

Paroxysmal (symptoms and syndromes that are observed during an ischemic attack)
permanent (observed for a long time and can be detected in the patient in the interictal period).

In the basin of the arteries of the vertebral-basilar system, the following may develop:

Transient ischemic attacks
ischemic strokes of varying severity, including lacunar ones.

The unevenness of arterial damage leads to the fact that brain stem ischemia is characterized by mosaic, “spotting”.

The combination of signs and the degree of their severity are determined:

Localization of the lesion
size of the lesion
opportunities collateral circulation

Described in classical literature neurological syndromes are relatively rare in their pure form in practice due to the variability of the blood supply system to the brain stem and cerebellum. It was noted that during attacks the side of the predominant motor disorders (paresis, ataxia) may change, as well as sensory disorders.

1. Movement disorders in patients with VBI are characterized by a combination of:

Central paresis
coordination disorders due to damage to the cerebellum and its connections

As a rule, there is a combination of dynamic ataxia in the limbs and intention tremor, gait disturbances, and unilateral decrease in muscle tone.
It should be noted that clinically it is not always possible to identify involvement in pathological process blood supply zones of the carotid or vertebral arteries, which makes the use of neuroimaging methods desirable.

2. Sensory disorders manifest themselves:

Symptoms of prolapse with the appearance of hypo- or anesthesia in one limb, half of the body.
Paresthesia may occur, usually involving the skin of the limbs and face.
disorders of superficial and deep sensitivity (occur in a quarter of patients with VBI and, as a rule, are caused by damage to the ventrolateral thalamus in the areas of blood supply to the a. thalamogeniculata or posterior external villous artery)

3. Visual impairment can be expressed as:

Loss of visual fields (scotomas, homonymous hemianopsia, cortical blindness, less often - visual agnosia)
appearance of photopsia
blurred vision, blurred vision of objects
the appearance of visual images - “flies”, “lights”, “stars”, etc.

4. Cranial nerve dysfunction

Oculomotor disorders (diplopia, divergent or convergent strabismus, eyeballs vertically),

Bulbar syndrome (less commonly pseudobulbar syndrome)

These symptoms appear in various combinations; their isolated occurrence due to reversible ischemia in the vertebrobasilar system is much less common. The possibility of combined damage to brain structures supplied by the carotid and vertebral artery systems should be taken into account.

5. Pharyngeal and laryngeal symptoms:

Feeling of a lump in the throat, pain, sore throat, difficulty swallowing food, spasms of the pharynx and esophagus
hoarseness, aphonia, feeling foreign body in the larynx, coughing

6. Attacks of dizziness (lasting from several minutes to hours), which may be due to the morphofunctional characteristics of the blood supply to the vestibular apparatus, its high sensitivity to ischemia.

As a rule, it is systemic in nature (in some cases, dizziness is non-systemic in nature and the patient experiences a feeling of sinking, motion sickness, instability of the surrounding space)
manifested by a sensation of rotation or linear movement of surrounding objects or one’s own body.
Associated autonomic disorders are characteristic: nausea, vomiting, profuse hyperhidrosis, changes in heart rate and blood pressure.

Over time, the intensity of the sensation of dizziness may weaken, while the emerging focal symptoms (nystagmus, ataxia) become more pronounced and become persistent.
However, it must be taken into account that the feeling of dizziness is one of the most common symptoms, the frequency of which increases with age.

Dizziness in patients with VBI, as well as in patients with other forms of vascular lesions of the brain, can be caused by suffering of the vestibular analyzer at various levels, and its nature is determined not so much by the features of the main pathological process (atherosclerosis, microangiopathy, arterial hypertension), but localization of the ischemic focus:

Lesions of the peripheral vestibular apparatus
damage to the central part of the vestibular apparatus
psychiatric disorders

Sudden onset of systemic dizziness, especially in combination with acutely developed unilateral deafness and a sensation of noise in the ear, may be a characteristic manifestation of labyrinthine infarction (although isolated dizziness is rarely the only manifestation of VBI).

Differential diagnosis of vertebrobasilar insufficiency

In addition to vertebrobasilar insufficiency, a similar clinical picture may have:

Benign paroxysmal positional vertigo (caused by damage to the vestibular apparatus and not associated with disorders of its blood supply; Hallpike tests are a reliable test for its diagnosis)

e violations)
pathology of the degenerative and traumatic nature of the cervical spine ( cervical dizziness), as well as craniocervical junction syndrome

Hearing impairment (decreased hearing acuity, tinnitus) are also common manifestations of VBI. It should, however, be taken into account that about a third of the older population systematically report a sensation of noise, while more than half of them regard their sensations as intense, causing them significant inconvenience. In this regard, all audiological disorders should not be regarded as manifestations of cerebrovascular pathology, given the high frequency of degenerative processes developing in the middle ear.

At the same time, there is evidence that short-term episodes (up to several minutes) of unilateral reversible hearing loss in combination with tinnitus and systemic vertigo are prodromes of thrombosis of the anterior inferior cerebellar artery, which requires close attention to such patients. As a rule, the source of hearing impairment in this situation is the cochlea itself, which is extremely sensitive to ischemia; the retrocochlear segment of the auditory nerve, which has rich collateral vascularization, is relatively less likely to suffer.

Diagnosis of vertebrobasilar insufficiency

In the diagnosis of VBI, ultrasound methods for studying the vascular system of the brain have now become the most accessible and safe:
Doppler ultrasound allows you to obtain data on the patency of the vertebral arteries, linear speed and the direction of blood flow in them. Compression-functional tests make it possible to assess the condition and resources of collateral circulation, blood flow in the carotid, temporal, supratrochlear and other arteries.
Duplex scanning demonstrates the condition of the arterial wall, the nature and structure of stenotic formations.
Transcranial Doppler ultrasound (TCDG) with pharmacological tests is important for determining cerebral hemodynamic reserve.
Doppler ultrasound (USDG) - detection of signals in the arteries gives an idea of ​​the intensity of microembolic flow in them, cardiogenic or vascular embologenic potential.
Data on the condition of the main arteries of the head obtained by MRI angiography are extremely valuable.
When deciding on thrombolytic therapy or surgical intervention on the vertebral arteries, contrast X-ray panangography becomes of decisive importance.
Indirect data on the vertebrogenic effect on the vertebral arteries can also be obtained from conventional radiography performed with functional tests.

The best method for neuroimaging brain stem structures remains MRI, which allows you to see even small lesions.

Otoneurological research occupies a special place, especially if it is supported by computer electronystagmographic and electrophysiological data on auditory evoked potentials characterizing the state of brain stem structures.

Studies of the coagulating properties of blood and its biochemical composition (glucose, lipids) are of particular importance.

The sequence of application of the listed instrumental research methods is determined by the peculiarities of determining the clinical diagnosis.

Treatment of vertebrobasilar insufficiency

The vast majority of patients with VBI receive conservative treatment outpatient setting. It must be borne in mind that patients with acute focal neurological deficit should be hospitalized in a neurological hospital, since the possibility of increasing thrombosis of a large arterial trunk with the development of stroke with persistent neurological deficit should be taken into account.

1. Modern understanding of the mechanisms of development of VBI, in particular the recognition of the leading role of stenotic lesions of the extracranial sections of the main arteries, as well as the introduction into clinical practice of new medical technologies, allows us to consider angioplasty and stenting of the corresponding vessels, endarterectomy, extra-intracranial anastomoses as an alternative to drug treatment of such patients, and in some cases the possibility of thrombolysis may be considered.

Information has been accumulated on the use of transluminal angioplasty of the main arteries, including the proximal segment, in patients with VBI.

2. Therapeutic tactics in patients with VBI are determined by the nature of the underlying pathological process, and it is advisable to correct the main modifiable risk factors for cerebrovascular diseases.

The presence of arterial hypertension requires an examination to exclude its secondary nature (renal hypertension, thyrotoxicosis, adrenal hyperfunction, etc.). Systematic monitoring of blood pressure levels and provision of rational diet therapy are necessary:

Restriction in the diet of table salt
avoiding alcohol consumption and smoking
dosed physical activity

If there is no positive effect, drug therapy should be started in accordance with generally accepted principles. Achieving the target pressure level is necessary primarily in patients with existing target organ damage (kidneys, retina, etc.) and suffering from diabetes mellitus. Treatment can be started with ACE inhibitors and angiotensin receptor blockers. It is important that these antihypertensive drugs provide not only reliable control of blood pressure levels, but also have nephro- and cardioprotective properties. A valuable consequence of their use is remodeling of the vascular bed, the possibility of which is also assumed in relation to the vascular system of the brain. If the effect is insufficient, it is possible to use antihypertensive drugs from other groups (calcium channel blockers, b-blockers, diuretics).

In elderly people in the presence of stenotic lesions of the main arteries of the head, a careful reduction in blood pressure is necessary, since there is evidence of progression of vascular damage to the brain with excessively low blood pressure.

3. In the presence of stenotic lesions of the main arteries of the head, a high probability of thrombosis or arterio-arterial embolism, an effective way to prevent episodes of acute cerebral ischemia is to restore the rheological properties of the blood and prevent the formation of cellular aggregates. Antiplatelet agents are widely used for this purpose. The most affordable drug that combines sufficient effectiveness and satisfactory pharmacoeconomic characteristics is acetylsalicylic acid. The optimal therapeutic dose is considered to be 0.5–1.0 mg per 1 kg of body weight per day (the patient should receive 50–100 mg of acetylsalicylic acid daily). When prescribing it, the risk of developing gastrointestinal complications should be taken into account. allergic reactions. The risk of damage to the mucous membrane of the stomach and duodenum is reduced with the use of enteric-soluble forms of acetylsalicylic acid, as well as with the simultaneous administration of gastroprotective agents (for example, omeprazole). In addition, 15–20% of the population has low sensitivity to the drug. The inability to continue monotherapy with acetylsalicylic acid, as well as the low effect of its use, require the addition of another antiplatelet agent or a complete replacement with another drug. For this purpose, dipyridamole, GPI-1b/111b complex inhibitor clopidogrel, and ticlopidine can be used.

4. Along with antihypertensive drugs and antiplatelet agents, drugs from the group of vasodilators are used to treat patients with VBI. The main effect of this group of drugs is considered to increase cerebral perfusion by reducing vascular resistance. At the same time, research recent years suggest that some of the effects of these drugs may be due not only to a vasodilatory effect, but also to a direct effect on brain metabolism, which must be taken into account when prescribing them. The appropriateness of their vasoactive agents, the doses used and the duration of treatment courses are determined by the patient’s condition, his adherence to treatment, the nature of the neurological deficit, blood pressure level, and the rate of achievement of a positive result. It is advisable to time the course of treatment to coincide with an unfavorable meteorological period (autumn or spring season), a period of increased emotional and physical stress. Treatment should begin with minimal dosages, gradually increasing the dose to the therapeutic dose. If there is no effect from monotherapy with a vasoactive drug, it is advisable to use another drug of a similar nature. pharmacological action. The use of a combination of two drugs with similar effects makes sense only in selected patients.

5. For the treatment of patients with various forms of cerebrovascular pathology, drugs that have a positive effect on brain metabolism and have a neurotrophic and neuroprotective effect are widely used. Piracetam, Cerebrolysin, Actovegin, Semax, glycine, and a large number of other drugs are used. There is evidence of normalization of cognitive functions due to their use in patients with chronic disorders cerebral circulation.

6. In the complex treatment of patients with BVN, symptomatic medications should be used:

Drugs that reduce the severity of dizziness
drugs that help normalize mood (antidepressants, anxiolytics, sleeping pills)
painkillers (if appropriate indications)

7. Rational connection non-drug methods treatment - physiotherapy, reflexology, therapeutic exercises.

The need to individualize the tactics of managing a patient with VBI should be emphasized. It is taking into account the basic mechanisms of the development of the disease and an adequately selected set of medicinal and non-medicinal treatment methods that can improve the quality of life of patients and prevent the development of stroke.

www.medicalj.ru

Vertebro-basilar circulatory system - what is it?

The paired vertebral and basilar arteries form the so-called vertebrobasilar system or system. They are responsible for the blood supply to the cervical region spinal cord and several parts of the brain - the brain stem, cerebellum, occipital lobe, as well as some parts of the temporal lobe, thalamus and hypothalamus.

What makes up the vertebrobasilar system?

The vertebral artery (a. vertebralis) is a pair. It branches off from one of the main arteries of the upper half of the body - the subclavian artery, which begins in the chest cavity. Both vertebral arteries run up the sides of the cervical spine (CS) and head to the brain. They are located in the bone canal, which is formed by holes in the transverse processes of the cervical vertebrae.

Reasons for the development of VBI

Vertebro-basilar insufficiency can be congenital or acquired. Congenital VBI is the result of various pathologies during pregnancy and childbirth.

Acquired VBI occurs as a result of disturbances in the processes of normal blood circulation or blood supply to blood vessels. And also with organic changes in the normal structure of the vascular wall of the vertebral and/or main arteries. The most common reasons for such changes are:

• Osteochondrosis SHOP.
• SHOP injuries.
• Atherosclerosis.
• Thrombosis.
• Inflammatory lesions of the vascular wall.
• Hypertension and others.

Osteochondrosis of the cervical spine is the cause of the development of the disease in almost half of the cases of all acquired VBI. Therefore, it makes sense to consider the nuances of VBN formation against the background of cervical osteochondrosis in more detail.

What happens with VBI and cervical osteochondrosis?

With the development of spinal osteochondrosis, various pathological changes in the bodies, arches and processes of the vertebrae, as well as the ligamentous apparatus of the spine, are often encountered.

Most often, the formation of compression (squeezing) of the vertebral artery is influenced by osteophytes - bone growths on the articular surfaces of the vertebrae. If the cervical vertebral segments are unstable, the articular process of the vertebra can also compress the artery.

The development of VBN against the background of cervical osteochondrosis is also called vertebral artery syndrome (or Barré-Lieu syndrome), which takes into account the level of damage to blood vessels.

Manifestations of VBI

Symptoms of vertebrobasilar insufficiency in cervical osteochondrosis are quite numerous. Moreover, most of them are nonspecific specifically for VBN, which significantly complicates diagnosis.

Systemic dizziness occurs. It manifests itself as the illusion of rotation of one’s own body or surrounding objects in a certain direction in space. It can be caused by many reasons, not just VBI. However, with vertebrobasilar insufficiency syndrome, hearing and vision impairment is often present and other neurological symptoms are not identified.

Usually develops paroxysmally. Its duration ranges from several seconds to several days. The development of an attack can be provoked by:

• head tilt, especially sharp or backward;
• forced position of the neck, for example, in an uncomfortable position during sleep, etc.

The attack is sometimes accompanied by nausea and vomiting, fainting.

Balance imbalance

Feeling unbalanced when standing or walking. Often combined with dizziness. There may also sometimes be attacks of sudden falling or sudden immobility (“drop attacks”).

Hearing impairment

They usually manifest themselves as a sensation of tinnitus, which initially occurs periodically, with forced or incorrect positions of the head and neck. The noise becomes constant over time. Hearing loss and ear pain are often observed.

Visual impairment

The most common complaint is blurred vision, as well as the appearance of spots before the eyes. Sometimes diplopia appears - double vision of objects, while the patient sees objects with a blurred or double contour. Visual acuity may decrease.

Other complaints and violations

With the development of VBI, patients present quite a lot of complaints. The most common of them, in addition to the above, are:

1. Headache. Often occurs in the back of the head or on one side of the head, reminiscent of a migraine. The nature of the pain is usually burning or dull, throbbing.
2. Memory impairment. Inability to Assimilate new material, rapid forgetting of events, “gaps” in memory.
3. Disorientation in time, place and situation.
4. Weakness, fast fatiguability.
5. Increased irritability, frequent mood swings and other signs of emotional lability.
6. Manifestations from the autonomic nervous system: hot flashes, increased sweating, increased heart rate, etc.

The most specific symptoms of vertebrobasilar insufficiency are dizziness in combination with disturbances in balance, as well as hearing and vision.

Diagnostics

Based on the patient’s characteristic complaints, as well as on the results of examination and additional research methods.

Inspection

When examining a patient, various functional neurological tests are performed to clarify the cause of, for example, dizziness and assess the severity of the patient’s condition.

Also, upon examination, signs indicating the presence of osteochondrosis of the spinal cord are revealed:

• pain and muscle tension in the cervical region;
• numbness and sensory disturbances in the upper extremities, etc.

Additional research methods

To clarify the diagnosis, they are widely used instrumental methods diagnostics If VBI is suspected, the following are used:

• X-ray examination of the spine to diagnose osteochondrosis and/or clarify the location and extent of lesions in it.
• Magnetic nuclear and computed tomography (MRI and CT). They are also carried out to diagnose osteochondrosis. They are more modern and accurate methods.
• Angiography – X-ray or using MRI, CT methods. A method of introducing contrast into a vessel, which makes it possible to identify its pathology.
• Doppler ultrasound examination. Allows you to give an accurate description of disorders in vertebral artery syndrome.
• Audiometry, fundus examination and other studies aimed at differential diagnosis of concomitant disorders in this syndrome.

It should be emphasized once again that often diagnosing vertebrobasilar insufficiency, which has developed against the background of cervical osteochondrosis, is a rather difficult task. Therefore, only a doctor should diagnose and prescribe treatment for VBI.

Treatment

When starting treatment for vertebrobasilar insufficiency syndrome, you should pay attention to the available therapy for the main cause of this condition – cervical osteochondrosis. Indeed, in the absence of treatment for the root cause of the disease, all therapeutic measures with VBI they lose their meaning.

It is necessary to observe an orthopedic regimen - to exclude overload of the cervical spine, wearing a Shants collar.

Medications

Apply various groups drugs. The most widespread vascular drugs, affecting the condition of blood vessels, improving microcirculation, venous outflow, etc. (Vinpocetine, Pentoxifylin, Sermion, etc.). Nootropic drugs that have a positive effect on the metabolic processes of the brain (Piracetam, Phezam) are also widely used.

Symptomatic and restorative treatment is carried out.

Physiotherapy

The use of medications is impossible without treatment with physical factors, since organic lesions of the cervical spine, unfortunately, cannot be corrected with medications.

Most of these treatment methods are used only during the period of subsidence of clinical manifestations - remission.

The most commonly used in physical therapy are:

• Manual therapy and massage. They are the leading methods of treatment for osteochondrosis of the spinal cord.
• Ultrasound treatment.
• Magnetotherapy.
• Electrophoresis with various drugs.
• Balneotherapy ( medicinal baths, souls).
• Paraffin applications and other treatment methods.

Exercise therapy

For vertebrobasilar insufficiency and cervical osteochondrosis, regular physical therapy exercises with a specially selected set of exercises are mandatory.

These exercises are aimed at strengthening the muscular corset of the neck and entire torso, improving blood circulation, and restoring the mobility of the vertebrae.

In conclusion, we should once again recall the need for combined treatment of VBI syndrome and the condition that caused it – osteochondrosis of the cervical spine.

medovet.com

Vertebro-basilar insufficiency: what is it?

The blood supply to the human brain occurs through following diagram: in the upper part of the sternum, the vertebral arteries separate from the subclavian arteries. They enter the openings of the transverse processes of the vertebrae of the cervical spine and enter the skull. At the base of the skull they merge into the basilar artery, which passes through the brain stem, cerebellum and occipital lobe of the cerebral hemispheres, after which it divides into vessels that supply arterial blood to the cerebral hemispheres.

If for a number of reasons, in particular due to osteochondrosis, the blood filling of these arteries decreases, a person develops vertebrobasilar insufficiency. Due to insufficient blood supply, the brain during VBI suffers from a lack of nutrients and oxygen, which affects its functioning. A person experiences symptoms characteristic of this syndrome. VBN often develops against the background of osteochondrosis of the cervical spine.

Vertebro-basilar insufficiency: causes

One of the main reasons for the development of vertebrobasilar insufficiency syndrome is osteochondrosis of the cervical spine. 75% of patients suffering from osteochondrosis develop vbn. With osteochondrosis, due to degradation of the intervertebral disc substance, deformation of the cervical vertebrae occurs. In this case, the vertebral arteries are compressed and blood flow is disrupted, which leads to a decrease in blood supply to the brain.

In addition to osteochondrosis, there are other reasons against which VBI occurs:

1. Innate tendency. Such reasons include developmental anomalies or genetically determined diseases of the blood vessels.
2. Cervical spine injuries.
3. Infectious diseases affecting the walls of the arteries.
4. Atherosclerosis, which leads to a decrease in blood filling of the arteries.
5. Metabolic disorders, in particular diabetes. When a person has diabetes, the blood supply to small arteries is reduced.
6. Dissection of the walls of large arteries, including the basilar artery.
7. Increased blood clotting, thrombus formation.
8. Hernia of the cervical spine or other factors leading to compression of the vertebral arteries.

Symptoms of the disease

The patient experiences permanent and temporary signs of the disease.
Temporary symptoms occur against the background of a transient ischemic attack. At the same time, the person becomes dizzy and feels severe pain, which is partly localized in the occipital region, pain or discomfort occurs in the cervical spine.

Persistent symptoms are constantly present and intensify as the disease progresses. These signs include:

• constant headaches, mainly in the occipital region. The pain can be pulsating or dull and pressing.
• hearing loss and recurrent tinnitus.
• decreased vision. Black spots may appear before the eyes. Objects may double or blur.
• decreased brain activity: poor memory, problems concentrating.
• deterioration in coordination of movements, loss of balance.
• chronic fatigue, fatigue, constant feeling of weakness, drowsiness.
• periodic dizziness, which can lead to fainting. When dizzy, a person may experience nausea.

• increased irritability, frequent mood swings.
• attacks of causeless tachycardia, increased sweating.
• voice disturbances, sore throat, hoarse voice.

If osteochondrosis is not treated and the VBD is corrected, the patient’s condition may worsen. As the disease progresses, a person may experience speech and swallowing problems. Severe complication disease is ischemic stroke.

Treatment of vertebrobasilar insufficiency

The condition of the vbn can be successfully corrected. It is important to promptly identify the disease and undergo appropriate treatment, which will improve blood circulation in the basilar arteries and normalize blood pressure. It is also important to treat osteochondrosis, as one of the main causes of vertebrobasilar insufficiency.

If VBP is not treated promptly, over time a person may develop chronic hypertension, the dangerous consequence of which is a stroke.

For the treatment of vertebrobasilar insufficiency, folk remedies and physiotherapeutic procedures are used. Also, patients with vertebrobasilar insufficiency will benefit from treatment with hirudotherapy (leeches) and acupuncture.

Treatment of osteochondrosis and vbn will be more successful if you undergo a course of massage and engage in physical therapy. Therapeutic exercises and massage help improve blood supply to the brain vessels and reduce the symptoms of VBI, and also strengthen the muscles of the cervical spine.

Treatment of the disease with folk remedies

Drug therapy for vertebrobasilar insufficiency includes vasodilators, blood thinners, and blood pressure-lowering drugs. Medicines can be replaced with folk remedies that effectively eliminate the symptoms of vbn.

Therapeutic exercise in the treatment of disease

Treatment of osteochondrosis of the cervical spine and vertebrobasilar insufficiency syndrome is not complete without therapeutic exercises. These exercises are simple and you can do them yourself at home. If you introduce daily practice of this set of exercises, the blood supply to the brain will improve and the symptoms of VBI will decrease.

Some tips for doing the exercises:

• When performing physical therapy, it is important to remember that sudden movements are prohibited. You need to listen carefully to yourself and stop the exercise if you feel dizzy.
• The number of repetitions of exercises should increase gradually; you cannot immediately apply a sudden load. The best indicator of the effectiveness of gymnastics will be your well-being. The best time It will be morning for exercise.
• After gymnastics, it will be useful to massage your neck, shoulders and back of the head and take a contrast shower.
• When performing gymnastics, you need to breathe calmly through your nose. You cannot hold your breath or, conversely, breathe too deeply.
• All exercises are done standing or sitting, and your posture should be straight.

Exercises:

nmed.org

Causes of the disease

The disease can be caused by various reasons. So, in middle-aged and young people main role external compression of the spinal arteries plays a role as a result of their compression bone growths(osteophytes), spasmodic neck muscles, disc herniation.

VBI can also develop as a result of deformation of the vertebral artery canal due to subluxation of the cervical vertebrae. In some patients, the disease is caused by developmental abnormalities such as spinal artery hypoplasia, accessory cervical rib, and Kimmerly syndrome.

Painful spasm of the spinal arteries plays a significant role in the development of VBI. Around the vertebral arteries there are small branches that arise from the autonomic nerves, from which the sympathetic nerve plexus is formed. With osteochondrosis, neck pain can cause the development of the disease. In addition, due to painful irritation of the spinal structures, hyperactivation of the sympathetic nerves innervating the spinal artery occurs, which is accompanied by its stable and prolonged spasm.

In elderly patients, vertebrobasilar insufficiency is often a consequence of atherosclerosis of the vertebral arteries. With this disease, atherosclerotic plaques containing large amounts of cholesterol form in the lumen of large arteries. As a result of the disease, the lumen of the arteries narrows, which leads to a decrease in blood flow in their pool.

Sometimes blood clots form at the locations of the plaques, which lead to an even greater narrowing of the lumen of the vertebral arteries. Disturbance in the movement of blood in the artery also occurs as a result of its blockage by a blood clot (thrombosis), which has formed in another place and migrates with the blood flow into the pool. This disease is called thromboembolism.

Rarely, dissection of the wall of a spinal artery resulting from gross medical manipulations with manual therapy and spinal injury, it can cause vertebrobasilar arterial system syndrome.

Stenosis of the subclavian artery, which supplies blood to the upper limb, is also the cause of the development of signs of the disease.

In fibromuscular dysplasia, a rare systemic disease, multiple stenoses of medium-sized arteries are formed. Sometimes the vertebral arteries are also involved in the process, which becomes the cause of the development of the disease.

Diagnostics

Diagnosing VBI first of all involves identifying the cause that caused the disease, as well as conducting a neurological examination.

The state of blood flow through the intracerebral vessels and main arteries of the head can be assessed using Doppler ultrasound. Combined modern systems, which include duplex scanning and Doppler ultrasound, make it possible to assess the condition of the spinal arteries.

Rheoencephalography and infrared thermography for diagnosing the disease are of much less value.

Magnetic resonance or computed tomography helps identify intervertebral disc herniations and other spinal diseases, which often cause vertebrobasilar insufficiency syndrome.

Based on radiography, the condition of the cervical spine is assessed. Functional tests with extension and flexion make it possible to determine spondylolisthesis.

Sometimes vestibulological research, recording of short-latency brainstem evoked potentials using audiometry, and acoustic stimulation are effective. Of no small importance in making a diagnosis are studies of the biochemical composition of the blood (lipids, glucose) and its coagulating properties.

Signs of illness

Vertebrobasilar insufficiency manifests itself in a variety of ways. Focal neurological signs combine conductive (sensory, pyramidal), vestibular and visual disorders, as well as dysfunction of the cranial nerves.

The severity and combination of symptoms are determined by the size of the ischemic lesion and its location, and the possibilities of collateral circulation.

Movement disorders in patients are manifested by impaired coordination and central paresis. Usually there is a combination of intention tremor and dynamic ataxia in the limbs, asymmetrical decrease in muscle tone.

Sensory disorders are characterized by hypo- or anesthesia on half the body or in one limb, and the development of paresthesia is possible.

A quarter of patients with VBI have disorders of deep and superficial sensitivity, which are caused by damage to the ventrolateral thalamus in the blood supply areas of the posterior external villous artery. Unfortunately, it is not always possible to determine clinically whether the blood supply zones of vertebrates or carotid arteries, as a result of which it is necessary to resort to neuroimaging methods.

Visual impairment occurs in the form of loss of visual fields (cortical blindness, scotoma, homonymous hemianopsia) or the appearance of photopsia.

If the brain stem is affected, cranial nerve dysfunction occurs. These are peripheral paresis of the facial nerve, oculomotor disorders, bulbar syndrome.

The above symptoms can appear in various combinations; their isolated appearance due to reversible ischemia in the vertebrobasilar system is much less common.

With anomalies of the vertebral artery and compression factors, cerebrovascular crises are intermittent and are often combined with cervical radiculitis. Symptoms of the latter are pain on palpation and limited neck mobility. Signs intensify when tilting and turning the head.

A manifestation of the disease can be an attack of dizziness, caused by the morphofunctional characteristics of the blood supply to the vestibular apparatus and its high sensitivity to ischemia. Dizziness is mixed or systemic, the patient feels straight motion, rotation of surrounding objects or one’s own body.

Another characteristic feature diseases - autonomic disorders, which are manifested by nausea, vomiting, changes in heart rate, increased pressure in the arteries, and profuse hyperhidrosis.

In complex coronary-cerebral crises, more pronounced disorders of the nervous system are observed with sensitivity disorders and loss of movements. They are so dominant in clinical picture that the idea of ​​primary brain pathology is erroneously created.

The patient develops problems with hearing (decreased hearing, a feeling of noise and congestion in the ears). Such symptoms are usually observed with ischemia in the area of ​​the anterior blood supply. inferior artery cerebellum.

It should be noted that many signs of this disease are also observed in other diseases. Thus, tinnitus and dizziness can be a sign of diseases of the inner ear, and drop attacks (unexpected falls while maintaining consciousness) can be a manifestation of epilepsy.

Treatment

The nature of vascular lesions determines the choice of specific treatment methods.

Mandatory actions in case of illness are:

1. Quitting bad habits such as smoking, drinking alcohol.
2. Regular blood pressure measurements.
3. Compliance therapeutic diet with limiting the amount of white bread, salt, fast food, spicy and smoked foods, canned food, marinades. It is recommended to include seafood, tomatoes, citrus fruits, bell peppers, and dietary cottage cheese in the diet. This is a kind of prevention of hypertensive crisis, which subsequently leads to the development of the disease.
4. Physical activity is necessary (their intensity should be moderate).

If there is no positive dynamics for six months, there is a need for physiotherapeutic and drug treatment.

On early stages For diseases, treatment measures are carried out in an outpatient setting, and at a later stage to prevent strokes - in a hospital.

Drug therapy

To treat the disease use:

1. Antiplatelet agents that reduce blood clotting. They must be used to prevent thrombosis. The most popular drug in this category is Aspirin. But this remedy negatively affects the gastrointestinal tract and can even lead to the development of bleeding in the stomach. Contraindications to the use of Aspirin are diseases of the digestive system. It is also not recommended to take the drug on an empty stomach.
2. Vasodilators for the prevention of vascular obstruction. Typically, such medications are prescribed in the spring or autumn. Initially, a small dosage is indicated, followed by its increase. If one drug cannot eliminate unpleasant symptoms, several medications with similar effects are used.
3. Nootropic and metabolic drugs (this group of drugs include Actovegin, Piracetam, Glycine, Seamax, Nicergoline) are used to improve brain function in VBI.

Drugs to normalize systemic pressure are prescribed strictly on an individual basis. Symptomatic treatment is indicated. Antidepressants, painkillers, sedatives, sleeping pills, dizziness medications, and antiemetics are used.

The use of all the medications described above will help eliminate the main symptoms of the disease.

Indications for surgery

If the disease is severe (this happens in rare cases), surgery may be necessary. The operation is performed to eliminate circulatory failure during VBI, caused by a reduction in the diameter of the basilar artery and spinal artery due to compression, stenosis, and tension. Typically, laser reconstruction of intervertebral discs, microdiscectomy, and endarterectomy are performed.

Non-drug treatment and physiotherapy

It should be noted that the approach to treating the disease should be comprehensive and include the prescription of physical therapy exercises and physiotherapeutic procedures along with medicinal treatment methods.

Additionally, vertebrobasilar insufficiency is treated with:

1. Special massage improves blood circulation.
2. Manual therapy.
3. Reflexology and acupuncture. These methods perfectly eliminate muscle spasms.
4. Gerudototherapy. This is enough effective method treatment of vascular diseases.
5. Magnetotherapy. An effective treatment method that has a beneficial effect on the condition of the circulatory system.
6. Wearing a special neck brace.

With properly selected and timely therapy, vertebrobasilar insufficiency is completely reversible. However, if the symptoms of the disease are ignored and the treatment is ill-equipped, chronic form diseases with frequent long-term transient ischemic attacks and constant deterioration of health.

Vertebro-basilar insufficiency (VBI, or vertebrobasilar system syndrome) is a violation of the blood supply in the arteries leading to the brain. As a result of vascular insufficiency, the nutrition of brain cells is disrupted, which leads to disorders of the central nervous system. VBI is one of the most common vascular diseases (about 20 cases per 1000 people). If left untreated, the most common complication is stroke.

Causes of VBI

There are a number of reasons that contribute to the development of vertebrobasilar insufficiency:

1. 1. VBI due to cervical osteochondrosis. 75 out of 100 people suffering from cervical osteochondrosis develop this disease. With osteochondrosis, degradation of the intervertebral disc occurs, resulting in the formation of vertebral deformity. This begins to compress the arteries and disrupt blood flow.
2. 2. Neck injuries.
3. 3. Atherosclerosis.
4. 4. High blood pressure.
5. 5. Hypoplasia of the vertebral arteries.
6. 6. Congenital anomalies of the vascular bed.
7. 7. Dissection of the vertebrobasilar artery.
8. 8. Diabetes mellitus.
9. 9. Thrombosis of the vertebral artery.
10. 10. Spondylosis, spondylolisthesis, vertebral hernia.
11. 11. Increased blood clotting.

Symptoms of the disease

There are temporary and constant signs VBN.

The first last from several hours to several days and represent an acute disturbance of blood circulation in the brain. The main features include:

• pressing pain in the back of the head;
• feeling of discomfort in the cervical spine;
• dizziness.

Persistent signs increase as VBI progresses and increase the threat of vertebrobasilar stroke. These include:

• headaches in the back of the head;
• nausea;
• heat in the head, hands, face;
• dizziness, which often leads to fainting;
• tachycardia;
• hearing loss;
• absent-mindedness;
• blurred image, spots or fog before the eyes;
• weakness and fatigue;
• sensation of a foreign body in the throat.

As the disease progresses, additional symptoms appear:

• labored breathing;
• speech impairment due to numbness in the mouth area;
• hallucinations;
• loss of vision;
• ischemic stroke.

Treatment of VBI

Treatment of this disease is a long process. The first priority is to eliminate the cause that caused VBI. Therapeutic methods are aimed at restoring normal blood flow to the cerebral vessels and eliminating hypoxia.

Treatment of vertebrobasilar arterial system syndrome consists of:

• drug therapy;
• physiotherapy;
• Exercise therapy and massage;
• traditional medicine;
• surgical intervention.

Drug treatment

The following types of drugs are prescribed for the treatment of VBI:

Group of drugs	Description
Vasodilates (vasodilators)	They are necessary to ensure vascular patency. Treatment usually begins with small doses, which are increased if necessary. If there is no effect from one drug, it is permissible to prescribe several drugs with similar action. The most commonly prescribed drug is nicotinic acid.
Antiplatelet agents	They are designed to reduce blood clotting and prevent blood clots. The most popular drug from this group is aspirin. But it negatively affects the gastrointestinal tract and leads to the formation of ulcers and stomach bleeding. Therefore, aspirin is not recommended for gastrointestinal problems. It is replaced with Clopidogrel, Ticlopidine, Dipyridamole
Metabolic and nootropic drugs	Designed to improve brain function. These include Glycine, Piracetam, Cavinton, Actovegin, Cerebrolysin
Drugs to regulate blood pressure	Antihypertensive drugs are prescribed strictly individually to normalize blood pressure
Antiemetics	Cerucal is most often prescribed intramuscularly or orally to relieve nausea.
Painkillers, sleeping pills, dizziness medications	These drugs are prescribed to reduce the symptoms of VBI

Physiotherapy

The optimal treatment for vertebrobasilar syndrome is an integrated approach, which includes taking medications, exercise therapy and physiotherapeutic procedures. Main types of physiotherapy:

• ultraphonophoresis, ultraphonotherapy - ultrasound, has a therapeutic effect and promotes the penetration of medicine into cells;
• magnetotherapy - a magnetic field increases the metabolic process in cells, accelerating metabolism, which decreases with this disease;
• laser treatment - has anti-inflammatory and thermal effects, improves microcirculation and metabolism;
• therapeutic mud - the method has a positive effect in the treatment of osteochondrosis;
• reflexology - with the help of needles, various points are affected, this technique allows you to get rid of pain and stimulates the nerve centers of the brain.

Massage and exercise therapy

For this pathology, it is only necessary massotherapy which is performed by professionals. With its help, muscles warm up, blood flow improves and blood vessels dilate.

Exercise therapy cannot be considered as the main method of therapy, but daily performance of special exercises improves blood supply to the brain and reduces symptoms.

Before performing the exercises, there are several rules to consider:

1. 1. During exercise therapy, sudden movements should not be made.
2. 2. If dizziness occurs, stop doing exercises.
3. 3. Increase the number of repetitions gradually.
4. 4. The morning is best for performing exercise therapy.
5. 5. After gymnastics, it is useful to massage the neck, shoulders and back of the head. At the end, take a contrast shower.
6. 6. When performing exercises, breathe evenly through your nose. Do not hold your breath or breathe too deeply.
7. 7. All exercises are performed in a standing or sitting position with a straight posture.

Set of exercises:

Exercise	Description, number of repetitions
Head tilts forward and backward	At extreme points, stop for a few seconds. Start with 5 bends in each direction
Slow tilts of the head alternately to the right and left shoulder	When performing the exercise, you do not need to raise your shoulders; you should stretch your ear to your shoulder. At extreme points, stop for a few seconds. Start with 5 bends in each direction
Head rotation	First, mentally draw a semicircle with your chin from one shoulder to the other and back. Then do the same, throwing your head back. Then do a full rotation of your head clockwise and counterclockwise. Start 5 rotations in each direction. Perform the exercise slowly, avoiding dizziness
Pull your head forward	When performing the exercise, the chin should move parallel to the floor, without falling lower. Pull your head out as far as possible and slowly return it to its place. Start with 10 repetitions
Standing, place your palms together and pull as high as possible	Freeze for a few seconds and lower your hands. Start with 10 repetitions
Turning the body to the sides	The hips remain motionless, only the body rotates ( top part torso). At the extreme point, freeze for a few seconds. Start with 10 turns in each direction
Swing your legs	Swings are made with a straight leg, while the toe points forward, the hip does not turn out. Freeze for a few seconds at the top point
Standing on one leg	Raise one leg, pressing the one that is standing to the inner surface of the thigh. Place your palms together and extend your arms up. It is recommended to stand with your eyes closed. If it is difficult to maintain balance, then you need to choose a point on the floor and look at it. Stand for 30 seconds on each leg
Plank	A good exercise that strengthens your back muscles. To perform it, you need to lie on the floor, rest your palms and raise your body and legs. The back and legs should be on the same line, the hips should not be higher or lower. Start with 30 seconds, gradually increasing the time

Folk remedies

Treatment with traditional medicine recipes is effective as a complement to basic therapy with drugs and physiotherapy. The most effective recipes:

Components	Mode of application
Lemon, cranberry orange, sea buckthorn, currant	These berries and fruits contain large amounts of vitamin C, which prevents the formation of blood clots. It's best to eat them raw.
Garlic, lemon, honey	It contains biochemical elements that help thin the blood. Pass 2-3 cloves of garlic through a meat grinder and pour 1 tbsp. l. lemon juice, add 1 tsp. honey Infuse the composition for a day. Divide the prepared product into 2 doses and eat 1 day before
Horse chestnut, alcohol	Horse chestnut improves blood clotting. Pour 500 g of fruit into 1.5 liters of alcohol. Leave for 7-10 days. Take 1 tsp. 1 hour before meals 3 times a day
Corn silk	They help stabilize blood pressure. 1 tbsp. l. pour a glass of boiling water over the herbs. Drink infusion throughout the day
Hawthorn fruits	Hawthorn promotes vasodilation. Pour 50 g of dry fruits with a glass of hot water and leave for 60-90 minutes. Drink 200 ml 30 minutes before meals 3 times a day
Yarrow, St. John's wort, immortelle, chamomile, birch buds	This composition helps to dilate blood vessels. For 500 ml of water take 1 tbsp. l. collection Brew in a thermos for half an hour. Drink instead of tea 2 times a day half an hour before meals for a month

All prescriptions must be agreed upon with the attending physician after an accurate diagnosis has been established.

Surgical intervention

Surgical treatment is performed in severe cases. The operation is performed to eliminate circulatory failure, which is caused by a decrease in the diameter of the artery due to spasm, stenosis or compression.

Vertebro-basilar insufficiency (VBI) occurs in the affected vessels of the brain, and vascular insufficiency- due to the broken cervical circulation The main and vertebral arteries cause brain cells to lack nutrition and oxygen. This leads to the appearance of disorders in the central nervous system.

Although vertebrobasilar insufficiency has a favorable course, cerebral and extracerebral vascular lesions can develop.

The main reason due to which vertebrobasilar insufficiency develops is stenosis of the main arteries, impaired microcirculation and hemostasis, and microangiopathy. The condition of the extracranial parts of the vertebral arteries worsens.

More often, stenosis appears in the area of ​​the artery at the entrance to the bone canal or directly to the site of formation of the main artery.

Sometimes a violation of cervical circulation occurs due to extravasal compression of the arteries passing through the vertebrae. Stenosis is rarely localized more proximally - in the area of ​​the innominate or subclavian arteries.

Causes of atherosclerosis

Blood flows poorly through the arteries as a result of atherosclerotic lesions, especially:

• the first segment, it is located in the area where the artery begins and enters the canal of the processes of the C5 and C6 vertebrae;
• the fourth segment, located between the zone where the dura mater of the brain perforates and the confluence with the vertebral artery that is located at the beginning of the base of the artery.

It is important to know. These areas are affected against the background of the special geometry of the vessels of the cervical spine, which predisposes to turbulent blood flow and injury to the endothelium in some places.

Vessels are affected by atherosclerotic stenoses, as well as abnormalities in the structure of the vascular bed in newborns.

Other causes of VBI

The functional functioning of the brain is also impaired due to:

1. Microangiopathies
   Against the background of underlying diseases: diabetes mellitus or arterial hypertension, VBI begins to develop due to damage to small cerebral arteries.
2. Incarceration of the vertebral arteries
   The vertebrae of the cervical spine change with spondylosis, osteochondrosis, the formation of large osteophytes, and the vessels are affected by compression. Acute compression of the vessel is often noted when turning the head, which reduces blood circulation.
3. Extravasal compression of the artery under the clavicle
   With osteochondrosis, the hypertrophied scalene muscle and altered transverse cervical processes of the vertebrae affect the vessel.
4. Acute injury
   As a result of transport (whiplash-like), iatrogenic (obtained during manual therapy) injuries, sudden movements during gymnastics, cervical circulation is disrupted.
5. Inflammation of the vascular wall
   With arteritis, a defect forms on the vessel wall, then the arteries become dissected: main or vertebral
6. Antiphospholipid syndrome
   It manifests itself with impaired vascular patency and increased formation of blood clots in young people and children.

Cerebral ischemia with VBI

Cerebral ischemia with VBI appears against the background of VBI as a result of additional factors in which:

• properties change, microcirculation is disrupted and the formation of blood clots increases;
• cardiogenic embolism is detected;
• due to a loose thrombus, several small arterio-arterial embolisms occur on the wall;
• a blood clot forms on the wall.

Due to the forced stay of the head in an uncomfortable position for a long time, especially in the presence of osteochondrosis, thrombosis increases.

According to studies, with VBI, changes occur in brain tissue: the occipital lobe cortex, cerebellum, brain stem, and pons.

Important. The variety of causes of VBI in a child or adult requires a thorough search for them in each individual case.

Symptoms

Signs of cerebrovascular accident are divided into 2 groups and can be temporary or permanent. Temporary disorders include symptoms of varying duration with the presence of transistor ischemic syndromes - disorders of cerebral blood circulation.

Symptoms of this group:

• pressing pain in the back of the head;
• discomfort in the neck area;
• dizziness.

Constant signs

Persistent symptoms tend to increase with the progression of the disease and provoke several ischemic attacks, which ends in vertebrobasilar stroke in children or adults.

Persistent symptoms of VBI are recognized by the presence of:

• acute pain in the back of the head;
• weakness and fatigue;
• paroxysmal dizziness and fainting;
• nausea, discomfort in the throat;
• ringing in the ears and hearing loss;
• weakening of memory and attention;
• decreased vision, blurred images, “bright spots” before the eyes, diplopia;
• tachycardia and irritability;
• heat in the head, face and hands;
• increased sweating.

Additional symptoms

Additional symptoms of pathology in children in the vertebrobasilar region are recognized by:

• difficulty swallowing;
• numbness of the mouth;
• impaired pronunciation of words;
• hallucinations;
• sudden falls;
• ischemic strokes.

Recognizing the symptoms of pathology in children

Vertebro-basilar insufficiency syndrome affects children from 3 years of age due to congenital anomalies vertebral or basilar arteries and injury. Parents should be on the lookout for symptoms indicating the following:

• lethargy and fatigue;
• causeless restlessness with frequent crying;
• the appearance of postural disorders;
• frequent daytime naps;
• inability to stay in a stuffy room;
• attacks of dizziness, often with fainting.

Dizziness occurs because vestibular apparatus sensitive to lack of cerebral blood supply.

Diagnosis confirmation

Diagnosis of VBI is aimed at a neurological examination to find out the underlying pathology in which it develops. Due to the variety of manifestations and the presence of similar signs in other diseases, the diagnosis of VBI becomes quite complex. To confirm circulatory failure, functional and de Klein tests are used. To confirm the diagnosis, turn the head in different directions and throw it back.

Perform hardware diagnostics:

• transcranial dopplerography, which evaluates the state of cerebral blood circulation;
• magnetic resonance angiography. It helps to examine the affected vessels in the vertebrobasilar region, to find out their length, extent and nature;
• computed spiral angiography. It is prescribed to visualize the lumen in the vessels and their walls;
• digital subtraction arteriography, through which the lumen in the vessels is visualized;
• rheoencephalography - to study cerebral blood circulation.

Diagnosis is carried out using neuropsychological tests to assess the patient's condition.

Treatment

The nature of vascular lesions determines specific treatment methods. Mandatory measures:

• blood pressure is measured daily;
• a salt-free diet is followed and the consumption of foods is limited: smoked, salted, spicy, peppered, fatty, fried. Fortified and lactic acid products are included in the diet;
• smoking and drinking alcohol are excluded;
• Medium intensity gymnastics is performed daily.

Use of medications

VBI treatment is performed:

1. Vasodilators (drugs that widen blood vessels)
   Treatment is prescribed for the purpose of vascular patency in osteochondrosis, spondylosis, spondylolisthesis in the spring and autumn seasons. Small doses are gradually increased. If the effect of one type of drug is insignificant, additional similar drugs are prescribed. Treatment begins with diuretics, ACE inhibitors (Captopril, Enelapril), calcium channel blockers (Amlodipine, Felodipine), beta blockers (Antenol, Metopropol, Bisopropol). If the pressure does not decrease, treatment is carried out with means for complex therapy(diuretic + ACE inhibitor, diuretic + b-blocker, beta blocker + calcium channel blocker).
2. Antiplatelet agents to reduce blood clotting
   These drugs prevent the formation of blood clots. Treatment is carried out with acetylsalicylic acid (aspirin). It should not be taken on an empty stomach or against the background of diseases of the digestive system. Instead of aspirin, Clopidogrel, Dipyridamole or Ticlopidine may be prescribed. The optimal therapeutic dose of aspirin is 0.5-1.0 mg/kg/day.
3. Metabolic and nootropic drugs
   Treatment with these drugs (Glycine, Piracetam, Actovegin, Cerebrolysin, Seamax, Nicergoline) improves the functional functioning of the brain.

Drugs to eliminate blood pressure and other symptoms are prescribed individually. Folk remedies are prescribed in general complex therapy. The drug Bilobil from the Gingko biloba plant is effective. Treatment with berries rich in vitamin C: cranberries, viburnum, sea buckthorn, lemons, oranges, kiwi, currants, and garlic thins the blood. Treatment with horse chestnut tincture reduces blood clotting.

Hypertension sufferers will be helped by folk remedies from the following collections:

• Steam lemon balm (20 g), corn silk (40 g) with boiling water and add lemon juice (1 lemon). After an hour, take 0.5 tbsp. half an hour before meals. After a week's course, take the same break.
• Make a mixture of rue, corn silk, mint and valerian in equal parts by weight. Place in a jar for storage. Pour boiling water (1 tbsp.) – 1 tbsp. l. collection and let it brew for 30 minutes. Before meals, drink a third of a glass for a course of 30 days.

Surgical interventions

In severe cases (with osteochondrosis, spondylosis), insufficient blood circulation (with a reduction in the diameter of the arteries) due to compression, stenosis, spasms is eliminated by operations:

• microdisectomy, which stabilizes the spine in the cervical region with osteochondrosis;
• endarterectomy removes atherosclerotic plaques from the lining of the arteries;
• laser reconstruction intervertebral discs with osteochondrosis;
• angioplasty - insertion of a special stent to widen the vessel and maintain blood flow to the brain.

Vertebro-basilar insufficiency (VBI) is a deterioration in the blood supply to the brain, causing disruption of its functions.

Similar pathological condition caused by obstructed blood movement through the vertebral arteries transporting oxygen and nutrients brain tissue.

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

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

A change in blood circulation at any segment of the vertebrobasilar system certainly affects the blood supply to the brain.

It has been noted that 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 disease are divided into congenital and acquired.

TO congenital causes relate:

• fetal development abnormalities;
• hypoxia of the unborn child;
• complications during childbirth that led to deformation of the baby’s blood vessels.

Among the acquired factors that provoked vertebrobasilar insufficiency syndrome, the following are distinguished:

• compression of the vertebral artery as a result of trauma to the cervical vertebrae, herniated intervertebral discs, hypertrophy of the scalene muscle, spondyloarthrosis;
• damage to small vessels in the brain caused by diabetes;
• dissection of arterial walls;
• high blood pressure;
• formation of blood clots in the vertebral artery;
• inflammatory processes affecting vascular walls;
• antiphospholipid syndrome;
• fibromuscular dysplasia.

Pathology also often occurs against the background of cervical osteochondrosis. Due to 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 conventionally divided into 2 types: temporary and permanent.

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

These signs are:

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

Constant manifestations tend to increase as the disease worsens. If there is no therapy, the patient’s well-being may deteriorate to the point of ischemic attacks on an ongoing basis, which significantly increases the risk of developing an ischemic stroke.

Constant manifestations of VBI:

• pressing painful sensations in the back of the head;
• regular dizziness;
• partial deafness, ear congestion;
• absent-minded attention;
• memory disorder;
• decreased vision (blurred boundaries and double vision of objects);
• lethargy, weakness;
• excessive irritability;
• increased heart rate;
• soreness and feeling of something stuck in the throat;
• sweating;
• weakness in the legs.

The symptoms that appear in children are also highlighted. The disease most often develops in the age period from 3 to 14 years and has quite striking manifestations.

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;
• poor posture.

Diagnostic methods

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

Since the occurrence of VBI is a consequence of an existing disease (for example, arterial hypertension, obstruction of 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 left and right, throwing the head back. If at such moments the patient begins to feel pain and feel dizzy, this indicates a disturbance in the movement of blood in the vertebral artery.

Next, the doctor prescribes blood tests to determine the causes of VBI. A blood test includes determining glucose levels, studying the electrolyte and lipid composition, the presence of antibodies to phospholipids, and considering indicators of the homeostasis system.

To accurately determine the diagnosis, neurology uses hardware diagnostic techniques:

1. Ultrasound examination with Dopplerography 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 even small affected areas.
3. Angiography is a technique using a contrast agent to detect deterioration of blood flow in the vertebrobasilar region.
4. Spiral computed angiography: carried out for the purpose of visualizing vessels and their walls, determining vascular patency.

It is not recommended to self-diagnose. It is necessary to consult a specialist to differentiate VBI from other pathologies that have similar manifestations.

Treatment

Therapeutic 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:

• Stop smoking and drinking alcohol.
• Adhere to a special diet, which involves avoiding salted, smoked, pickled and spicy foods, processed foods, and canned foods. Add seafood, dried fruits, citrus fruits, low-fat cottage cheese, and bell peppers to the menu.
• Measure your blood pressure every day.
• Fulfill physical exercise moderate severity.

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

On initial stage The disease is usually treated on an outpatient basis. If the condition worsens and there is severe dysfunction, the patient is hospitalized in the inpatient neurology department.

The prognosis for recovery largely depends on the cause of the disease.

If the disease is in the stage of compensation, then there is every chance of achieving a satisfactory quality of life; with decompensation and the development of ischemic stroke, approximately 20% of patients experience disability and complete incapacity for work.

Drug therapy

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

Drugs used as part of complex therapy for vertebrobasilar insufficiency:

1. Vasodilators (vasodilators) are used to prevent vascular obstruction. They are usually used in the spring and autumn, 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 medications is necessary to reduce the risk of blood clots. Aspirin is considered the most popular remedy, but in the presence of diseases of the gastrointestinal tract, its use may be limited. Among the analogues, Clopidogrel, Ticlopidine, Dipyridamole are prescribed.
3. Means to enhance brain nutrition: Glycine, Piracetam, Semax.
4. Drugs to improve metabolism in brain tissue: Cavinton, Korsavin, Cinnarizine, Actovegin.
5. Medicines to normalize blood pressure.

Additionally, medications are also prescribed to eliminate unpleasant symptoms:

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

In case of exacerbation of vertebrobasilar insufficiency, Vinpocetine can be administered intravenously at a dosage of 5, 10 or 15 mg, having previously dissolved it in 500 ml of saline. As the acute phase of the condition subsides, the patient switches to taking Vinpocetine orally.

Physiotherapy

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

It includes the following techniques:

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

Exercise therapy

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

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

All exercises are easy to perform. The basic rule of therapeutic exercises is that you need to move smoothly, without jerking or effort. During physical activity, you need to monitor your breathing rhythm: breathe through your nose at a calm pace.

The most effective gymnastic techniques for VBI:

1. Stand with a straight back, point your toes together. Tilt your head forward, trying to touch your chin to your chest. Stay in this position for 10 seconds and return to the original 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. Repeat the same manipulation on the left side.
3. Smoothly and leisurely 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 your arms along your body. You need to raise your hands up and put your palms together for 10 seconds. Then lower your hands.
6. Raise both legs alternately, fixing the position with the raised leg for 10 seconds.
7. Stand on one leg, maintaining 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 classes therapeutic exercises in combination with medication and physiotherapy, they help cure chronic VBI.

Surgical intervention

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

Types of operations performed for VBI:

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