Vertebral Artery Insufficiency

Question 1

Pathological Stages of VAI

Answer 1

Early Stage: Transient reduction in blood flow without tissue damage

Progressive Stage: Persistent vascular narrowing, intermittent ischemia

Chronic Stage: Permanent changes or ischemic damage to brainstem/cerebellum

Acute Stage: Vertebrobasilar stroke or infarction

Question 2

Presentation of VAI (5 D’s + 3 N’s + A)

Answer 2

5 D’s:
Dizziness (most common)
Drop attacks (sudden collapse without fainting)
Diplopia (double vision)
Dysarthria (speech difficulties)
Dysphagia (difficulty swallowing)

3 N’s:
Nystagmus (uncontrolled eye movements)
Nausea/vomiting
Numbness (especially facial)

A -
Ataxia (poor coordination)
(Also Headache (occipital)

Question 3

Causes & Risk Factors for VAI

Answer 3

Mechanical Compression:
• Cervical spine hyperextension/rotation
• Osteophytes (bony growths)
• Neck trauma or whiplash
Atherosclerosis:
• Plaque buildup narrowing the vertebral arteries
Other:
• Arterial dissection
• Connective tissue disorders (Ehlers-Danlos, Marfan)
• Smoking and hypertension

Question 4

Red Flags for VAI

Answer 4

Dizziness or vertigo triggered by neck movement
Sudden, severe occipital headache
Visual disturbances (blurred or double vision)
Unexplained drop attacks
Numbness or weakness on one side of the body
Speech difficulties (dysarthria)