VBI (vertebrobasiliar insufficiency)

Question 1

Definition

Answer 1

Insufficiency blood supply to the brain due to the disruption in blood flow supplied by the carotid or vertebral artery
– disruption to the posterior blood flow

VB arteries supply- cerebellum, medulla, midbrain and occipital cortex
– when blood supply to these areas is compromised, it can lead to severe disability and even death

Question 2

Aetiology

Answer 2

Atherosclerosis

May be due to:
– emboli or thrombosis (both can be due to atherosclerosis)
– aneurysm
– arterial dissection
– vascular compression secondary to cervical stenosis
– instability
– bony anomally
– soft tissue mass

Documented causes:
– childbirth
– overhead fork
– turning head while driving
– wrestling/yoga
– fitness exercise
– sleeping position
– swimming
– cervical mobilisation

Question 3

Epidemiology

Answer 3

Incidence is extremely rare

Age- general risk of stroke increases with age

Gender:
– higher in females

no genetic predisposition known for VBI

Question 4

Risk factors:

Answer 4

Atherosclerosis (by far the most common)

History of TIA, head and neck trauma (MVA), hypertension, diabetes, dyslipidaemia, smoking, oral contraceptive use

Ligamentous hyper mobility or atlanto-axial (C1-C2) instability (downs syndrome, spondylolisthesis, marfans syndrome)

Question 5

Pahtophysiology

Answer 5

Decreased perfusion can cause it

Can be caused by emboli:
– these emboli can be atherosclerotic plaques that can later break off and form an emboli
– can also occur from trauma (fragments of bone)

Pathophysiology of atherosclerosis will be able to be stated here

Question 6

Symptoms

Answer 6

5 D’s 3 N’s and 1 A:
– dizziness, vertigo, giddiness (more than 60% of pts diagnosed with VBI have at least one episode of dizziness during the disease)
—– these 3 are hallmark symptoms the pt may state ‘they feel like their drunk’
– diplopia
– dysarthria
– dysphagia
– drop attacks

– nausea and vomiting
– numbness
– nystagmus

– ataxia

– pt may have headache or neck pain that is worse or differing from any they have had before

Possible vertebral artery pain referral:
– side of the head behind the ear and just above eye and into eyelid

Question 6

Symptoms

Answer 6

5 D’s 3 N’s and 1 A:
– dizziness, vertigo, giddiness (more than 60% of pts diagnosed with VBI have at least one episode of dizziness during the disease)
—– these 3 are hallmark symptoms the pt may state ‘they feel like their drunk’
– diplopia
– dysarthria
– dysphagia
– drop attacks

– nausea and vomiting
– numbness
– nystagmus

– ataxia

– pt may have headache or neck pain that is worse or differing from any they have had before

Possible vertebral artery pain referral:
– side of the head behind the ear and just above eye and into eyelid

Question 7

Investigations

Answer 7

VBI test or George’s test

Question 8

Treatment