Vertebrobasilar

insufficiency
A disorder caused by decrease of blood flow
in the vertebral or basilar arteries due to
atherosclerosis or compression placed on the
external wall of the arteries. Symptoms may
include loss of vision, dizziness, or nausea.
Also called VBI, vertebrobasilar circulatory
disorders, or posterior circulation ischemia.
transient ischemia of the brain stem and
cerebellum due to stenosis of the vertebral or
basilar artery
Baloh 1996,
Vertigo merupakan gejala yg paling sering
muncul pada insufisiensi
vertebrobasilar,namun tidak selalu jelas
organ mana yang mengalami iskemi.
 vertigo or dizziness
difficulty walking properly
double or Blurred Vision
difficulty talking or controlling the movements of
the mouth
numbness around the mouth
weakness or numbness on one or both sides of
the body.
Some patients have "drop attacks," experiencing
weakness of both legs and collapse without
losing consciousness
At times, these symptoms may worsen with a
changes in posture, when extending or bending
the neck, or when moving or lifting the arms.
 Vertigo with associated Neurological signs
Diplopia
Ataxia
Drop attacks
Dysarthria
Paralysis/weakness/Numbness
Headache
Risk factors (HTN, Diabetes, Coronary
Disease)
 Radiographs of the cervical spine of 32 elderly patients
clinically diagnosed as having vertebrobasilar
insufficiency secondary to cervical spondylosis were
compared with 32 age- and sex-matched controls. The
mean age was 77.6 years. There was no significant
difference in the severity of the radiological changes
between the two groups as judged by the narrowing of
disc space and marginal osteophyte formation.
It is concluded that there is no place for routine
examination of the cervical spine in patients thought to
have vertebrobasilar insufficiency secondary to cervical
spondylosis
PATIENTS AND METHODS: Forty-six patients with vertebrobasilar ischemia and
40 control subjects were examined during head rotation using transcranial
Doppler ultrasonography. RESULTS: In the control group, no difference in blood
flow velocity through the BA was found between the neutral and rotated
positions. Based on these data, a blood flow reduction in the BA of more than
20% was considered to be significantly abnormal (p < 0.01). In three of 46
patients no signal was detectable in the BA using TCD. The reduction in blood
flow velocity through the BA during head rotation was strongly dependent on the
condition of the VA; none of 23 patients without atherosclerotic lesions or
hypoplasia of the VA developed a significant reduction in blood flow through the
BA. Two of 11 patients with unilateral VA lesions had significantly reduced blood
flow in the BA (27% and 31%), although both were asymptomatic. Five of nine
patients with bilateral VA lesions showed a significant reduction in blood flow
through the BA (mean = 52%, minimum = 30%), and four of these developed
clinical symptoms such as vertigo or diplopia during the rotation maneuver.
CONCLUSION: These data suggest that patients with uni- or bilateral lesions of
the VA are at risk for developing clinically relevant reductions in blood flow
through the BA during head rotation. Because not all patients with VA lesions
developed reduced blood flow velocity, we conclude that individual vascular
mechanisms must play an important compensatory role.
Syndrome of Vertebrobasilar Artery Occlusion:
- Binocular visual loss
- Diplopia
- Vertigo
- unilateral or bilateral weakness, numbness or clumsiness :
- can alternate between right and left side in different
attacks
- can be crossed, with some symptom right and others
on left
- Ataxia
- Dysarthria
- Dysphagia
- Hearing loss
- Drop attack
- Sign of cerebellum disfunction

(Adams Jr. et al., 2002)