From the Guidelines
Vertebral basilar artery insufficiency presents with distinct symptoms including dizziness, vertigo, visual disturbances, difficulty speaking, weakness or numbness, coordination problems, difficulty swallowing, and headaches, which can be triggered by head positions or movements and may indicate a risk for stroke. These symptoms result from reduced blood flow to the posterior brain, affecting vital functions like balance, coordination, vision, and basic life functions. According to the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1, symptoms associated with vertebral artery disease include dizziness, vertigo, diplopia, perioral numbness, blurred vision, tinnitus, ataxia, bilateral sensory deficits, and syncope. The guideline also notes that compromised vertebrobasilar perfusion is not the only mechanism of symptoms, as atheroembolism may cause brainstem or cerebellar infarction.
Some key points to consider:
- Symptoms can be transient, lasting minutes to hours, and may be triggered by certain head positions or movements, particularly neck extension or rotation.
- Patients may experience drop attacks, nausea, vomiting, and in severe cases, loss of consciousness.
- Treatment typically involves addressing underlying causes such as atherosclerosis, managing risk factors, and may include antiplatelet medications like aspirin (81-325mg daily) or clopidogrel (75mg daily), along with lifestyle modifications.
- It is essential to seek immediate medical attention if symptoms recur or persist, as they may indicate a risk for stroke, as highlighted in the guideline 1 and supported by other studies 1.
In clinical practice, distinguishing vertebral basilar artery insufficiency from other causes of vertigo, such as benign paroxysmal positional vertigo (BPPV) or migraine-associated vertigo, is crucial, as noted in a clinical practice guideline on BPPV 1. The type of nystagmus, severity of postural instability, and presence of additional neurological signs are main distinguishing features between vertebrobasilar insufficiency and BPPV. Given the potential for severe outcomes, prioritizing morbidity, mortality, and quality of life, prompt medical evaluation and appropriate management are critical for patients presenting with symptoms of vertebral basilar artery insufficiency.
From the Research
Symptoms of Vertebral Basilar Artery Insufficiency
The symptoms of vertebral basilar artery insufficiency can vary, but common symptoms include:
- Dizziness
- Vertigo
- Headaches
- Vomit
- Diplopia (double vision)
- Blindness
- Ataxia (loss of coordination)
- Imbalance
- Weakness in both sides of the body 2 These symptoms are often caused by transitory ischemia of the vertebrobasilar circulation, which can be due to atherosclerosis or other factors.
Clinical Features
Clinical features of vertebral basilar artery insufficiency can also include isolated dizziness, which may occur as an isolated symptom in some patients 3. In some cases, patients may experience stroke, myocardial infarction, or sudden death 4.
Diagnostic Testing
Diagnostic testing for vertebral basilar artery insufficiency may include magnetic resonance angiography, transcranial Doppler ultrasound, and vertebrobasilar deprivation testing 2. Angiography may also be used to diagnose the disease, but it is important to consider the inherent risks of this exam.
Treatment Options
Treatment options for vertebral basilar artery insufficiency may include anticoagulation therapy, such as warfarin or aspirin, as well as stent-assisted angioplasty for patients with medically refractory symptoms 3, 5. However, further studies are needed to clarify optimal therapy for these patients.