From the Guidelines
Symptoms of a vertebral artery (VA) infarction typically include sudden onset vertigo, nausea, vomiting, gait instability, nystagmus, and head-motion intolerance, which may be accompanied by other brainstem or cerebellar symptoms such as difficulty swallowing, hoarseness, double vision, facial numbness, weakness on one side of the body, and problems with coordination. These symptoms occur because the vertebral arteries supply blood to the brainstem, cerebellum, and posterior portions of the brain, so when blood flow is interrupted, these areas cannot function properly 1. Patients with vertigo of any cause are often initially evaluated in the emergency department, and the detection rate of contributory central nervous system pathology in those with a normal neurologic examination remains very low, highlighting the importance of a thorough examination and diagnostic approach 1.
Key Symptoms
- Sudden onset vertigo
- Nausea and vomiting
- Gait instability
- Nystagmus
- Head-motion intolerance
- Difficulty swallowing
- Hoarseness
- Double vision
- Facial numbness
- Weakness on one side of the body
- Problems with coordination
The most worrisome cause of acute vertigo to be excluded is a posterior circulation infarct involving the brainstem or cerebellum, and various bedside tests like the HINTS examination have been developed to distinguish acute vertigo of benign cause from posterior circulation infarct 1. Immediate medical attention is crucial if these symptoms occur, as prompt treatment may be necessary depending on the cause, and delayed diagnosis can lead to permanent neurological damage as brain tissue dies rapidly without adequate blood supply.
From the Research
Symptoms of Vertebral Artery Infarction
The symptoms of vertebral artery infarction can vary, but some common symptoms include:
- Dizziness or vertigo 2, 3, 4
- Blurred vision 3
- Nausea and vomiting 2, 3
- Tinnitus (ringing in the ears) 3
- Unfavorable movement of the limbs 3
- Ataxia (loss of coordination) 3
- Dysarthria (speech difficulties) 5
- Headache 5
- Sensory and cognitive deficits 2
Diagnostic Considerations
Diagnosis of vertebral artery infarction often involves a combination of clinical presentation, imaging studies, and laboratory tests. Some key diagnostic considerations include:
- Magnetic resonance imaging (MRI) to visualize ischemic lesions and vascular abnormalities 2, 3, 5
- Angiography to evaluate vascular occlusion and dissection 2, 5
- High-resolution vessel wall MRI to detect arterial dissection 3
- CT digital subtraction angiography to evaluate vascular occlusion 3
Clinical Presentation
The clinical presentation of vertebral artery infarction can be acute or subacute, with symptoms developing over hours or days. Some patients may present with sudden onset of symptoms, while others may experience a more gradual progression of symptoms 2, 3, 5. The presence of vascular risk factors, such as hypertension or atherosclerosis, can increase the likelihood of vertebral artery infarction 4.