Vertebra-basilar insufficiency - a reversible disruption of brain function caused by a decrease in blood supply.
Causes
- Cerebrovascular accident
- Atherosclerosis
- Elevated blood pressure
- vascular inflammation (Takayasu disease, for example)
- artery bundle
- Fibro-muscular dysplasia
- Compression of the subclavian artery hypertrophied scalene muscle.
- The presence of congenital malformations of the vascular bed
- Compression of the vertebral artery caused by lesions of the cervical spine (spondylolisthesis, herniated disc)
- Thrombosis vertebral and (or) the basilar artery
- The defeat of the small cerebral arteries caused by diabetes diabetes
Manifestations of vertebrobasilar-basilar insufficiency
Picture vertebrobasilar-basilar insufficiency is extremely diverse. One of its most frequent manifestation occurs is suddenly dizziness. The frequency of this feature may be due to features of the blood supply to the vestibular apparatus, very sensitive to blood supply insufficiency.
The majority of patients with vertebrobasilar-basilar insufficiency giddiness manifests itself in the form of rotational or linear motion sensations surrounding objects or own body. Typically dizziness occurs quickly and lasts from a few minutes to hours. Generally, it is accompanied by disturbances such as nausea, vomiting, sweating, changes in heart rate and blood pressure. In some cases, the patient experiences a sensation of falling through, motion sickness, fragility of the environment. Movement disorders in patients with disorders of blood circulation in vertebrobasilar-basilar system lies in the development of weakness and clumsiness in the limbs. Frequent manifestation is unilateral hearing loss -
sensorineural hearing loss.Diagnostics
Diagnosis of vertebrobasilar-basilar insufficiency is the neurological examination and requires clarification leading cause of its development (arterial hypertension, Impaired permeability or intracranial main artery and so forth.).
Estimation of blood flow state of the great arteries of the head and intracerebral vessels carried by means of Doppler ultrasonography. Modern combined system, including Doppler and duplex scanning, allow us to estimate the state of the vertebral arteries.
Valuable information is provided by carrying out functional tests with hyperventilation (evaluation of functional reserve of cerebral circulation). Significantly smaller diagnostic value are the infrared thermography and rheoencephalography.
Assessment of the state of the cervical spine is carried out on the basis of X-ray; functional tests of flexion and extension can detect spondylolisthesis. Neuroimaging studies (computed tomography or magnetic resonance imaging) is indispensable for identifying herniated disk, Other structural lesions of the spinal cord and spinal column.
You can use the MR angiography provides information on the state of the brain vascular bed, without resorting to intravenous contrast agents. In some cases, valuable information can be obtained at vestibulologicheskom inspection, recording of short-stem evoked potentials to acoustic stimulation audiometry. Certain studies have value coagulation properties of blood and its biochemical composition (glucose, lipids).
Treatment vertebrobasilar-basilar insufficiency
The main directions of the treatment of vertebrobasilar-basilar insufficiency determined by the nature of vascular lesion. A regular (daily) blood pressure control and mandatory diet correction (Restriction of salt diet), with the exception of alcohol consumption and smoking, dosed physical load.
In the absence of a positive effect for 3-6 months should be medication. Treatment begins with diuretics, ACE inhibitors (captopril, enalapril), calcium channel blocker (amlodipine, felodipine), beta-blockers (atenolol, metoprolol, bisoprolol). If necessary (lack of effect of treatment, poor tolerability of drugs) is carried out replacing the drug from a different pharmacological group. If in this case there is a positive effect in reducing blood pressure, you must the use of combined therapy (diuretic + ACE inhibitor, a diuretic + b-blocker, beta-blocker, a calcium blocker + channels).
For those patients in whom the cause of vertebrobasilar-basilar insufficiency is atherosclerosis, effective attacks prevention method is restoring properties of the blood and prevent the formation of blood clots. The most common drug possessing antithrombotic effect is acetylsalicylic acid. It is now believed that the optimal therapeutic dose of the drug is 0,5-1,0mg / kg body weight per day (the patient should receive daily 50-100 mg acetylsalicylic acid).
The impossibility of application of acetylsalicylic acid requires the use of certain drugs, in particular, dipyridamole. The daily dose may vary from 75 to 225mg (25 to 75mg 3 times daily), in some cases, the daily dose may be increased to 450mg. Dipyridamole is taken 1 hour before a meal, do not chew the tablet, and washed down with a little water. Course duration of application of dipyridamole is typically 2-3 months. Cancellation is made gradually reduced dose for 1-2 weeks. The drug is contraindicated in acute myocardial infarction, angina rest, severe congestive heart failure, heart rhythm disorders.
Modern drugs are antithrombotic action clopidogrel, ticlopidine. Improve cerebral circulation may contribute nicergoline. The maintenance dose of nicergoline is set individually and 5-10mg 3 times a day. Performed well cinnarizine. Treatment begins with minimal doses (12.5 mg 3 times daily), with a gradual increase in dose (25-50mg 3 times a day after meals). Piracetam is used by 0.8 g of 3 times a day for 2 months, Cerebrolysin 5-10 5-10 ml of intravenously administrations in the course of therapy.
Very convenient combination is a drug Fezam containing cinnarizine 25mg and 400mg piracetam. The undoubted advantage of the drug is the convenience of dosing. The effect is observed when taking 1-2 capsules 3 times a day. Duration of treatment is determined individually and depends on the nature and severity of neurological deficit and an average of 1,5-3 months. Carnitine hydrochloride is administered intravenously 5-10ml of 20% solution in 300-400ml of physiological (isotonic) solution, treatment of 8-12 injections.
To eliminate the dizzy spells at vertebrobasilar-basilar insufficiency is well established betahistine. Betahistine applied on 8-16 mg 3 times a day. It is advisable to start the treatment with low doses of the drug, gradually increasing them if necessary. The course of treatment long-term (2-3 months). To reduce the intensity of vertigo and associated symptoms episodes (nausea, vomiting), particularly provokes movement meklozin assigned. The daily dose is variable and ranges from 25 to 100mg.
The prognosis of the disease
Forecast vertebrobasilar-basilar insufficiency depends on the nature and severity of the underlying cardiovascular the disease, the degree of destruction of the vascular bed and capabilities to ensure the bypass cerebral circulation brain.
Progressive narrowing of the arteries, persistent hypertension without adequate therapy are the precursors of poor prognosis. These patients are at high risk of stroke or formation vascular encephalopathy with persistent neurological deficits.
The satisfactory condition of the vascular system of the brain, adequately planned treatment strategy associated with a relatively mild course of vertebrobasilar-basilar insufficiency and a favorable prognosis.
