Vertebral artery insufficiency

Question 1

what is vertebral artery insufficiency

Answer 1

also known as vertebrobasilar insufficiency is defined by inadequate blood flow through the posterior circulation of the brain, supplied by the 2 vertebral arteries that merge to form the basilar artery

the vertebrobasilar arteries supply the cerebellum, medulla, midbrain, and occipital cortex. when the blood supply is compromised to these areas it can lead to disability and/or death.

Question 2

what is the Etiology of VBI

Answer 2

certain risk factors predispose patients to VBI, particulary those that lead to or exacerbate atherclerosis. for example;
- smoking
- hypertension
- age
- gender
- family history and genetics
- hyperlipidemia
as well as this are co-morbities with other cardiovascular conditions such as infective endocarditis, VAD and atrial fibrilliation.

Question 3

who is most effected

Answer 3

about a quater of strokes and TIA occur due to VBI. this means it often occurs later in life around 7 to 8 decade of life with predominance in males. which can lead to damage to the cerebellum and thus there are increased falls and impaired balance as a consequence of VBI.

Question 4

explain the patho of VBI

Answer 4

there are usually 2 processes of ischemia: hemodynamic insufficiency and embolism.

hemodynamic - decreased blood flow causes most VBI as with strokes. Hemodynamic ischemia occurs to inadequate blood flow through the basilar artery. for this to occur there is an occlusion of both vertebral arteries as well as an incomplete ciculation by the carotid circulation via the circle of willis.

Embolism - VBI may also originate from atherosclerotic plaques that later break off to form emboli. However, emboli may also develop as a result of intimal defects secondary to trauma, compression

Question 5

what are the symptoms of VBI

Answer 5

Symptoms of VBI are a result of ischemia on the different parts of the brain supplied by the posterior circulation.
- vertigo
- dizziness/ syncope
- ‘Drop attacks’
- diplopia
- paresthesia
- dysphagia
- headache
- ataxia

Question 6

how is VBI diagnosed and treated/managed

Answer 6

Noninvasive CTA or MRA is commonly used to visualize the vertebral-basilar system to define stenosis or occlusions
Duplex ultrasound may also be used for abnormalities within the vertebral artery.
Blood work should involve a complete CBC, electrolytes, renal function, coagulation profile, lipid profile, and liver function.