Vertebrobasilar circulatory disorders

Causes

Three main blood vessels provide blood flow to the back of the brain:

• One basilar artery
• Two vertebral arteries

This part of the brain contains structures that are crucial for keeping a person alive, such as breathing, heart rate, swallowing, vision, movement, and posture or balance. 

Many different conditions may cause blood flow in the back part of the brain to be reduced or stopped. The most common are smoking, highblood pressure, diabetes, and high cholesterol levels. These are similar to the risk factors for any stroke.

Vertebrobasilar vascular disorders may also be caused by a tear (dissection) in an artery wall.

Other less common causes of vertebrobasilar vascular disorders include connective tissue diseases and vasculitis.

Symptoms

Most common symptoms may include:

• Difficulty saying words
• Difficulty swallowing
• Double vision or vision loss
• Numbness or tingling most often on the face or scalp
• Slurred speech
• Sudden falls (drop attacks)
• Vertigo (sensation of things spinning around)
• Memory loss

Other symptoms that may occur include:

• Bladder or bowel control problems
• Difficulty walking (unsteady gait)
• Headache
• Hearing loss
• Muscle weakness
• Nausea and vomiting
• Neck ache
• Pain in one or more parts of the body, which gets worse with touch and cold temperatures
• Poor coordination
• Sleepiness or even apparent sleep from which the person cannot be awakened
• Sudden, uncoordinated movements
• Sweating on the face, arms, or legs

Exams and Tests

Tests depend on the possible underlying cause, but may include:

• CT or MRI of the brain
• Computed tomography angiography (CTA), magnetic resonance angiography (MRA), or ultrasound to look at blood vessels in the brain
• Blood tests, including blood clotting studies
• Echocardiogram
• Electrocardiogram (ECG) and Holter monitor
• X-rays of the arteries (angiogram)

Treatment

Sudden onset of vertebrobasilar symptoms is a medical emergency that requires immediate treatment. Treatment is similar to that for stroke .

Treatment and prevention may include:

• Blood-thinning medications to lower your risk of stroke, such as aspirin, warfarin (Coumadin) or clopidogrel (Plavix)
• Diet changes and medication to lower cholesterol and control blood pressure
• Exercise
• Losing weight
• Stopping smoking

Outlook (Prognosis)

The outlook depends on:

• The type of stroke
• The amount of brain damage
• What body functions have been affected
• How quickly you get treatment
• How quickly you recover

Each person has a different recovery time and need forlong-term care. Problems with moving, thinking, and talking often improve in the first weeks or months after a stroke. Some people will keep improving months or years after a stroke.

Possible Complications

Complications of vertebrobasilar circulatory disorders are stroke and its complications. The complications of stroke include:

• Respiratory (breathing) failure (which may require use of a machine to help the patient breathe)
• Lung problems (especially lung infections)
• Heart attack
• Dehydration and swallowing problems (sometimes leading to the placement of tubes in the stomach for artificial feeding)
• Problems with movement or sensation, including paralysis and numbness
• Formation of clots in the legs

Patients may have vision loss in one eye.

Complications caused by medications or surgery may also occur.

When to Contact a Medical Professional

Call 911 or your local emergency number, or get to the emergency room if you have any symptoms that may suggest a vertebrobasilar circulatory disorder.

Alternative Names

Vertebrobasilar insufficiency; Posterior circulation ischemia

References

Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:227-276.

Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517-584. 

Adams RJ, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2008 May;39(5):1647-52. Epub 2008 Mar 5.

Biller J, Love BB, Schneck MJ. Vascular Diseases of the Nervous System. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 55.

Update Date: 8/29/2012

Updated by: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.