What is Vertebrobasilar Insufficiency?
Vertebral artery dissection (VBA) is a rare condition where the blood supply to part or all of the brain is blocked. The main symptoms are weakness, numbness, tingling sensations and sometimes paralysis in one or both legs. VBA affects approximately 1 in every 100,000 people worldwide.
The most common location of VBA is the brainstem, which includes the brain stem, spinal cord and parts of the brain responsible for breathing and heart rate control. Other locations include the cerebellum, eyes and ears. The condition may occur at any age but usually occurs between ages 15 and 30 years.[1]
Symptoms vary from person to person depending on their age when they develop it. Some people with VBA experience no symptoms while others suffer from severe symptoms such as paralysis of one or both limbs.
Causes and Risk Factors
There are several factors that contribute to developing VBA, including:
Age – People tend to get the condition later in life than younger individuals. Approximately 20% of cases occur before the age of 40 years.
Medical conditions – Some medical conditions like connective tissue diseases, migraine headaches, carotid artery disease and neck or back trauma may increase the risk of developing VBA.
Others factors – Other factors that might increase the risk of developing VBA include cigarette smoking, alcohol abuse, blood vessel abnormalities, family history of the disease and female gender.
The exact cause of VBA is unknown but there are several theories that attempt to explain its development. These include:
Debris in the blood vessels – Small pieces of cholesterol or other foreign materials in the blood vessels may cause a clot to form, which can block the flow of blood to part of the brain.
Hereditary factors – When one identical twin has VBA, the other twin has an increased risk of also developing the disease.
Stress – Stressful events, such as a sudden shock or trauma, may trigger the occurrence of VBA in people who are genetically predisposed to developing it.
The blood vessels in the brain and spinal cord are susceptible to injury because they do not contain protective covers (called meninges) like other parts of the body.
Symptoms
VBA can affect any age group but typically develops later in life. The earlier in life the condition occurs, the more likely it is to cause permanent damage. In most cases, the left vertebral artery is affected over the right.
The signs and symptoms of VBA may be different from person to person. It may also affect people differently depending on what area of the brain is deprived of oxygen.
The following are the most common symptoms of VBA:
Loss of movement or weakness in the legs – The legs may become weak or paralyzed, leading to loss of movement, muscle control and balance. Inability to walk is one of the most common signs of this condition.
Loss of vision or double vision – Vision loss can occur in one or both eyes. In some cases, the vision may be blurry or double in both eyes.
Difficulty in speaking – Difficulty in speaking or slurred speech is another common sign of VBA.
Poor memory or confusion – Memory loss and confusion are other signs of this condition.
Loss of coordination – VBA can cause problems with balance and coordination.
Loss of sensation or tingling – Some people experience numbness or tingling in their arms, hands, legs or feet.
Headache – Many people with VBA suffer from recurring headaches. These types of headaches are different and more severe than the usual kind. These may be the result of increased pressure within the skull.
Aura – Some people experience an aura before suffering a stroke. These symptoms may include a tingling or numbness sensation in the face or limbs, visual disturbances (blurring or flashing), problems speaking, swallowing or breathing, and dizziness. The symptoms may occur on one side or both sides of the body.
Diagnosis
After ruling out other potential causes for the signs and symptoms, your doctor will diagnose VBA via a detailed medical history and by asking the right diagnostic questions.
You or your doctor may then order the following diagnostic tests:
Imaging tests – These help visualize the blood vessels in the brain and detect blockages. The two most common types are CT scans and MRI scans.
Angiography – In this procedure, a special X-ray is used to image the brain’s blood vessels. A solution that contains a special dye is injected into the bloodstream, which allows the vascular system to be visualized on an X-ray monitor. This test is typically performed after a CT or MRI scan shows that the internal carotid artery, one of the main blood vessels that supply blood to the brain, is severely narrowed or blocked.
Treatment
The goal of treatment for VBA is to restore blood flow to the brain. This will help reverse any damage that may have occurred and prevent any further harm.
The most common treatment is a medical procedure called an endarterectomy. During this procedure, the blockage is removed and the artery is returned to its original state. The surgery may be performed using a microscope called a endoscope or using open surgery depending on the location and extent of the blockage.
Recovery from endarterectomy is very successful if the disease is caught in its earliest stages.
Prevention
The best way to prevent VBA is to maintain low cholesterol levels and control your weight. High cholesterol and fat levels in the blood increase the risk of blood clots. It is also important to quit smoking and manage any other medical conditions, such as diabetes or high blood pressure, that may put you at risk of having a stroke.
It is also very important to have regular check-ups with your primary care physician or a neurologist. During these visits, your risk factors for developing VBA will be assessed and treated if necessary.
By taking the necessary precautions and treating any underlying conditions, you can reduce your risk of developing VBA.
Complications
If the blood flow to a certain part of the brain is severely reduced or cut off, that part of the brain can no longer function. This can lead to weakness or paralysis on one side of the body, speech problems, and loss of vision or touch. In severe cases, death may result if enough of the brain is affected.
Prognosis
The outlook is good if VBA is treated early. According to the National Institute of Neurological Disorders and Stroke, most people who have a stroke caused by VBA recover completely within three months. However, there may be some long-term or permanent effects. There is also a small risk of a second stroke in the other carotid artery.
Additional Info
The National Institute of Neurological Disorders and Stroke: ninds.nih.gov
The American Heart Association: heart.org
The Brain Attack Coalition: brainattackcoalition.org
This article was provided by iVillage, Inc. Sources
American Heart Association
Mayo Clinic
National Institute of Neurological Disorders and Stroke
National Stroke Association
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Sources & references used in this article:
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Vertebrobasilar insufficiency: A review by JI Ausman, CE Shrontz, JE Pearce, FG Diaz… – Archives of …, 1985 – jamanetwork.com
Vertebrobasilar insufficiency: part 2: microsurgical treatment of intracranial vertebrobasilar disease by LN Hopkins, NA Martin, MN Hadley, RF Spetzler… – Journal of …, 1987 – thejns.org
Vertigo and vertebrobasilar insufficiency by GW Bruyn – Acta Oto-Laryngologica, 1988 – Taylor & Francis
Deafness associated with vertebrobasilar insufficiency by T Yamasoba, S Kikuchi, R Higo – Journal of the neurological sciences, 2001 – Elsevier
Complications of intracranial bypass for vertebrobasilar insufficiency by LN Hopkins, JL Budny – Journal of neurosurgery, 1989 – thejns.org
Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band: case report by T Mapstone, RF Spetzler – Journal of neurosurgery, 1982 – thejns.org
