Vertebrobasilar artery insufficiency in the elderly

Introduction to vertebrobasilar insufficiency in the elderly Vascular basilar artery insufficiency (vertebrobasilarischemia, VBI) refers to a syndrome caused by cervical spondylosis, cerebral atherosclerosis, hypertension or hypotension, which is mainly caused by dizziness, dizziness, rotational sensation, nausea and vomiting. A common cerebrovascular disease in the elderly. basic knowledge The proportion of illness: 0.003% Susceptible people: the elderly Mode of infection: non-infectious Complications: syncope arteriosclerosis

The cause of vertebrobasilar insufficiency in the elderly

(1) Causes of the disease

The vertebral artery is emitted from the bilateral subclavian artery and rises in the transverse cavity of the 6th to 1st cervical vertebrae. After entering the skull through the occipital foramen, the basilar artery is merged at the lower edge of the pons and divided into the left and right sides of the brain. Artery, vertebral basilar artery divides many branches in the brain, and its blood supply area includes cranial nerves in the brainstem, ascending and descending conduction bundles, auditory vestibular organs, temporal lobe, occipital lobe and thalamus, etc., when blood supply is insufficient, it appears Complex clinical symptoms, and due to different parts, degree, collateral circulation, the majority of the causes are cervical spondylosis, cerebral atherosclerosis, hypertension arteriosclerosis, other such as hypotension, cerebral arteritis Distorted large blood vessels in the neck, heart disease, vascular malformation, hypercoagulable state, subclavian artery stealing syndrome, etc. may also be the cause of the disease.

(two) pathogenesis

The pathogenesis can be summarized as follows:

1 hemodynamic changes: a certain artery of the vertebral basilar artery system is severely stenosis or occlusion. The collateral circulation can still maintain the blood supply. Once the blood pressure is lowered, the cerebral blood flow is reduced, and the blood supply is reduced by the collateral circulation. Transient ischemia can occur in the area.

2 mechanical factors: vertebral artery due to arteriosclerosis or congenital distortion, too long and twisted, or cervical vertebra hyperplasia oppression of the vertebral artery, when the head and neck are too stretched, overflexion, or turn to one side often can appear insufficient blood supply.

3 vascular wall lesions: the most common are cerebral arteriosclerosis, including atherosclerosis and hypertension arteriosclerosis, in addition, there may be cerebral arteritis, congenital vascular abnormalities, vascular injury and other factors.

4 other: such as cerebral arterial steal syndrome, cerebral vasospasm, hypercoagulable state, severe anemia, etc. In short, vertebrobasilar insufficiency is caused by multiple factors, cervical spondylosis, cerebral atherosclerosis and hypertensive arteries Hardened patients are most common.

Prevention of vertebrobasilar insufficiency in the elderly

Establish a regular living system, pay attention to the combination of work and rest, avoid excessive mental stress and excessive fatigue, properly participate in some physical labor or physical exercise within the limits of your ability, diet should be lighter, properly control calories, avoid obesity, and add more protein and vitamins. Food, smoking and alcohol abuse are important risk factors for cerebrovascular disease. Avoiding smoking and moderate alcohol consumption are important for preventing the occurrence and development of arteriosclerosis and for controlling vertebrobasilar insufficiency.

Elderly vertebrobasilar insufficiency complications Complications syncope arteriosclerosis

Can be complicated by syncope, electrolyte imbalance, cerebral arteriosclerosis and so on.

Symptoms of vertebrobasilar insufficiency in the elderly Common symptoms Inability to hearing loss dizziness, head swelling, vertigo, ataxia, diplopia, nausea, nausea and vomiting

The main symptoms are paroxysmal vertigo, nausea, vomiting, tinnitus and hearing loss. The vertigo occurs when the head and neck rotate rapidly or the position changes. It is rotatory, floating or swaying, and the lower limbs are soft. Unstable standing, ground movement or tilting, usually lasts for a few minutes, hours or days, about 40% of people with visual impairment, manifested as blurred vision, diminished, double vision, visual or black Mongolian, if the brain is dry Or when the cerebellum is damaged, there are nystagmus, ataxia, balance disorder, difficulty in swallowing, dysarthria and cross-sexual paralysis. A few patients have a tripping episode, often bursting into the lower limbs when they turn quickly. , clear consciousness, can stand on their own, recover in a few seconds or minutes, and the brain stem reticular ischemia causes a sudden decrease in somatic muscle tone. In addition, there may be migraine, memory loss and mental abnormalities. A large number of sympathetic ganglia fibers are attached around the vertebral artery. Therefore, vertebral basilar artery insufficiency caused by vertebral artery type cervical spondylosis is often accompanied by autonomic dysfunction, and the stomach appears. Intestinal, respiratory and cardiovascular symptoms. Positive Horner sign on the lesion side, there may be neck pain, posterior occipital pain, limited neck activity, nervous system positive signs are very slight, may have horizontal nystagmus, mild pyramidal tract signs (such as muscle strength) Decreased, sputum reflexes active or hyperactive, abdominal wall reflex asymmetry, etc.), Romberg sign positive, finger nose test is not accurate, facial or limb sensation is reduced. The following tests have some help in the diagnosis of vertebrobasilar insufficiency:

1 flexion neck test: the patient sits on the side, bows his head and bends the neck, and closes the neck to the chest. If there is dizziness within 30 seconds, the head swelling symptoms, the test is positive.

2 neck extension test: the end of the head back, over-extension, so that the face and forehead is horizontal position, if within 30s, the dizziness is aggravated or the head pain is positive, 3 neck test: sitting neck or neck, Turn left or right to the neck 45 ° or more, observe the side of the neck when there is dizziness, head swelling symptoms, positive for most of the ischemic side.

Examination of vertebrobasilar insufficiency in the elderly

Patients with severe vomiting, potassium, chlorine can be abnormal.

1. Cervical vertebra filming includes positive position, lateral position, oblique position and over-extension position to determine whether the patient has abnormal cervical hyperplasia, narrow intervertebral space, and cervical disc herniation.

2. Transcranial Doppler ultrasonography (TCD) According to its spectral image, average envelope blood flow velocity (vm) and pulsatility index, vertebral artery (VA) and basilar artery (BA) can be detected from the occipital window. The hemodynamics of the vertebrobasilar artery and its main branches were clearly determined. It is speculated that there is stenosis or spasm in the lumen, which provides evidence for the diagnosis of vertebrobasilar insufficiency.

3. Brainstem auditory evoked potential (BAEP) has a positive value for the diagnosis of vertebrobasilar insufficiency. It has been widely accepted by many scholars. Because of the degree of brain stem damage, the length of time between onset and BAEP, and the lesion itself. The pathological nature of the difference can make the positive rate of BAEP different. Domestic literature reports that patients with vertigo caused by vertebrobasilar insufficiency, the abnormal rate of BAEP can reach 34.3% to 75.0%, a group of patients with transient ischemic attack in our hospital The BAEP abnormal rate is 82.8%, indicating that BAEP is a valuable auxiliary diagnosis method. If combined with color Doppler ultrasonography of the extracranial segment of the vertebral artery, the effect is better.

4. The vestibular function test is mainly used for cold and heat tests, and some cases have single or bilateral vestibular dysfunction.

5. The nystagmus can objectively trace the direction, speed, frequency, amplitude of the nystagmus and some nystagmus that is difficult to observe with the naked eye.

6. Head and/or cervical CT or MRI examination to understand whether there are other lesions in the brain stem or posterior fossa. CT scan of the cervical spine is clearer than ordinary plain film. It can be found that cervical vertebrae hyperplasia, ligament calcification, narrow intervertebral space, neck Intervertebral disc prolapse and vertebral deformity changes, CT or MRI in the display of transverse stenosis and vertebral artery compression have mutual verification, complement each other, may be used as appropriate, to identify vertebral basilar artery blood supply caused by vertebral artery type cervical spondylosis Have a higher value.

7. Other tests such as blood lipids, blood sugar, blood viscosity, fundus, electrocardiogram, etc. are also helpful in determining the blood supply to the vertebral basilar artery.

Diagnosis and diagnosis of vertebrobasilar insufficiency in the elderly

Differential diagnosis

1. Meniere's disease (Meniere's disease), also known as inner ear vertigo, is due to excessive secretion or absorption of endolymph, causing membrane labyrinth edema, resulting in increased endolymphatic pressure, leading to enlargement of the endolymphatic cavity and hypoxic degeneration of the inner ear Caused by clinical epileptic vertigo, volatility deafness, tinnitus as the three main signs, vertigo can burst at any time, is a rotation, more dramatic, can not walk or stand, closed eyes can be relieved, often accompanied by Nausea, vomiting, paleness and blood pressure drop, each episode lasts for several hours to several days, and the seizure has nothing to do with neck activity. The cold and hot test shows that the affected side has vestibular dysfunction, the hearing test is sensorineural deafness, and the imaging examination has no cervical vertebrae. Disease performance, TCD and BAEP examinations help identify.

2. Brain stem or cerebellar infarction such as cerebellar inferior arterial thrombosis (bulbar dorsolateral syndrome), clinical vertigo, nausea, vomiting, nystagmus, dysphagia, soft sputum on the lesion side and vocal cord paralysis, ataxia, ipsilateral Department and contralateral half-body pain, temperature-sensing disorder, Horner sign positive, long duration, CT or MRI examination is of great value for the diagnosis.

3. The cerebellopontine angle tumor is more common in acoustic neuroma, meningioma and trigeminal neurofibroma. CT or MRI can confirm the diagnosis.

4. Acute vertigo of vestibular neuronitis, moderate to severe, with horizontal nystagmus, no deafness, tinnitus and nervous system localization signs, vestibular function cold and heat test weakened on both sides, longer course, sustainable 4~ 6 weeks.

5. Benign paroxysmal positional vertigo is closely related to position. When a particular head position occurs, moderate vertigo, nausea and vomiting are rare. Horizontal or rotational nystagmus lasts for 10-20s. The test can gradually adapt to no longer appear dizziness and nystagmus, hearing and vestibular function is normal, no signs of nervous system localization.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.