A15. Clinical syndromes of impaired circulation of the vertebrobasilar sys Flashcards
LIST Clinical syndromes of impaired circulation of the vertebrobasilar system
- Vertebrobasilar insufficiency
- Ischemic stroke
- Hemorrhagic stroke (Intracerebral hemorrhage, Subarachnoid stroke)
what forms basilar artery?
vertebral artery
vertebral artery and its branches supply
medulla and the
inferior surface of the cerebellum before forming the basilar artery
basilar
artery supplies
brain stem from the medulla upwards and
divides into
posterior cerebral arteries and posterior communicating arteries
basilar artery divides into
divides into
* posterior cerebral arteries and
* posterior communicating arteries
vertebrobasilar system supplies
- cerebellum,
- pons,
- medulla,
- midbrain,
- thalamus and
- the occipital cortex
As a consequence the
symptoms can vary depending on which areas are affected.
what is Vertebrobasilar insufficiency
VBI is a set of symptoms due to ischemia in the posterior circulation
of the brain
● The symptoms are usually transient and resolves within 24 hours
how are symptoms in Vertebrobasilar insufficiency?
● The symptoms are usually transient and resolves within 24 hours
Vertebrobasilar insufficiency General symptoms
○ Drop attacks (weakness of quadriceps → fall to the ground)
○ Diplopia
○ Dysarthria
○ Dizziness
○ Vertigo
○ Dysphagia
○ Dyequilibrium,
○ ataxia
○ alternating syndromes
Vertebrobasilar insufficiency causes
usually caused by
* atherosclerosis,
* hypertension,
* diabetes,
* smoking,
* dyslipidemias.
* Postural changes, exercise and
dehydration can also cause these
symptoms
treatment of Vertebrobasilar insufficiency
Treatment often includes
* lifestyle changes
* treatment of underlying conditions.
* Patients can also get started on antiplatelet or anticoagulation.
* Angioplasty is a possibility for treatment of vertebrobasilar stenosis.
what can be used as treatment of vertebrobasilar stenosis.
Angioplasty is a possibility
Ischemic stroke
● Causes
○ Atherosclerosis: most common cause, causes stenosis and occlusion
○ Dissection: not so common
○ Vasculitis
○ Embolism: plaques from atherosclerosis
-cardioembolic stroke: due to atrial fibrillation, mural thrombus, CHF
○ Lacunar type: occlusion of small vessels
where do ischemic strokes occur which areas
-
territorial (in the distribution territory of large arteries)
*thrombotic (local atherosclerotic plaque)
*embolic (embolus = plug) -
border zone (in the watershed areas of large vessels,
*hemodynamic causes -
small vessel disease
*lacunar infarct
what is cerebral venous sinus thrombosis?
can the term “stroke” be used to?
This is called cerebral venous sinus thrombosis
addition to arterial disturbances of cerebral blood, venous disturbances of cerebral blood may also occur.
However, the term “stroke” is usually used to denote cerebral blood flow disturbance on the arterial side
what is stroke?
However, the term “stroke” is usually used to denote cerebral blood flow disturbance on the arterial side
can ischemic stroke transform into hemorrhagic stroke?
yes after a few days (more common in cardioembolic stroke)
Hemorrhagic stroke types
Intracerebral hemorrhage
Subarachnoid stroke
Intracerebral hemorrhage
○ Causes:
- hypertension,
- trauma,
- vascular malformations,
- vasculitis,
- drug use
Most common areas where Intracerebral hemorrhage can occur
- putamen,
- thalamus,
- pons and
- cerebellum