Acute Discirculation in the Vertebro Basilar Basin. Diagnosis of LBN: symptoms, diagnosis, treatment options, forecasts and prevention, neurologist tips

Vertebro Basilar Insufficiency is a reversible violation of brain functions caused by a decrease in blood supply.

The reasons

• Acute violation of cerebral circulation
• Elevated blood pressure
• Inflammation of vessels (sickness of such, for example)
• Artery bundle
• Fibrozno muscular dysplasia
• Clearing the connector artery hypertrophied staircase.
• The presence of congenital abnormalities for the development of the vascular bed
• Crowning of the vertebral artery, due to the defeat of the cervical spine (spondylolisthesis, disk hernia)
• Vertebral thrombosis and (or) main arteries
• Defeat of small brain arteries due to diabetes

Manifestations of vertebro-basilar insufficiency

The picture of vertebro-basilar insufficiency is extremely diverse. One of the most frequent manifestations is suddenly occurring dizziness. The frequency of this feature may be due to the peculiarities of the blood supply to the vestibular apparatus, very sensitive to the insufficiency of blood supply.

In most patients with vertebro-basilar insufficiency, dizziness is manifested in the form of a sensation of rotation or rectilinear movement of surrounding items or its own body. Usually dizziness occurs quickly and continues from a few minutes to hours. As a rule, it is accompanied by disorders in the form of nausea, vomiting, sweating, changing the frequency of heart rate and blood pressure level. In some cases, the patient experiences a feeling of falling, indicating, aspects of the surrounding space. Motor disorders in patients with circulatory disorders in the vertebro-based system are concluded in the development of weakness and awkwardness in the limbs. A unilateral decline in hearing is unilateral manifestation - neurosensory touginess.

Diagnostics

The diagnosis of vertebro-basilar insufficiency lies in a neurological examination and requires clarification of the leading cause of its development (arterial hypertension, violation of the maintenance of trunk or intracranial arteries, etc.).

Assessment of the condition of blood flow through the main arteries of the head and intracerebral vessels is carried out with the help of ultrasonic dopplerography. Modern combined systems, including dopplerography and duplex scanning, allow you to estimate the state of the vertebral arteries.

Valuable information provides functional trial with hyperventilation (evaluation of the functional reserve of the cerebral circulation). Significantly smaller diagnostic value is infrared thermography and reophiecephalography.

The assessment of the condition of the cervical spine is carried out on the basis of radiography; Functional samples with bending and extension allow you to identify spondylolisthesis. Neurovisualization study (computed tomography or magnetic resonance imaging) is indispensable to identify the hernia of an intervertebral disc, other structural lesions of the spinal cord and spine.

It is possible to use MR-angiography, which allows to obtain information on the state of the vascular channel of the brain, without resorting to the intravenous administration of contrast drugs. In some cases, valuable information can be obtained with a vestibular survey, registration of short-prophent stem caused potentials for acoustic stimulation, audiometry. Studies of coagulating properties of blood and its biochemical composition (glucose, lipids) have a certain meaning.

Treatment of Vertebro Basilar Insufficiency

The main directions of treatment of vertebro-basilar insufficiency are determined by the nature of the damage to the vessels. Regular (daily) control of blood pressure and mandatory diet correction (restriction in the diet of the table salt), elimination of alcohol and smoking consumption, dosage exercise.

In the absence of a positive effect for 3-6 months, medication therapy should be carried out. Treatment begins with diuretic, ACE inhibitors (captopril, enalapril), calcium channel blockers (amlodipine, feelodipine), beta blockers (Atenolol, metoprolol, bisoprolol). If necessary (lack of effect from treatment, poor portability of medicines) is replaced by a drug from another pharmacological group. If in this case there is no positive effect on the reduction in blood pressure level, it is necessary to use complex therapy (diuretik + ACE inhibitor, diuretic + B-blocker, beta blocker + calcium channel blocker).

In those patients whom the cause of vertebro-basilar insufficiency is atherosclerosis, an effective way to prevent attacks is the restoration of blood properties and preventing the formation of thromboms. The most common preparation with a countertilombotic effect is acetylsalicylic acid. Currently, it is believed that the optimal therapeutic dose is the reception of 0.5-1.0 mg / kg of weight per day (the patient should receive 50-100 mg of acetylsalicylic acid daily).

The impossibility of using acetylsalicylic acid requires the use of other drugs, in particular, dipyridamole. The daily dose may vary from 75 to 225mg (25 to 75mg 3 times a day), in some cases the daily dose can be increased to 450mg. Dipyridamol is accepted 1 hour before meals, the tablet is not chewmed and is powered by a small amount of water. The duration of the application of dipyridamol is usually 2-3 months. The abolition is made gradually, the dose decreases for 1-2 weeks. The drug is contraindicated in acute myocardial infarction, rest angina, severe congestive heart failure, heart rate disorders.

Modern anti-terrorism drugs are clopidogrel, Tiklopidine. Improving cerebral circulation can be promoted by nicegolin. The supporting dose of niccoline is established individually and is 5-10mg 3 times a day. Cynnarizin has proven well. Treatment begins with minimal dosages (12.5 mg 3 times a day) with a gradual increase in dose (25-50mg 3 times a day after meals). Used piracetams of 0.8 g 3 times a day for 2 months, cerebrolysin of 5-10 ml intravenously 5-10 administrations on the course of therapy.

A highly convenient combination is a drug of flames containing 25 mg of cinnarizin and 400mg piracetam. The undoubted advantage of the drug is the convenience of dosing. The effect is observed when receiving 1-2 capsules 3 times a day. The duration of the course of treatment is determined individually and depends on the nature and severity of the neurological deficit and on average is 1.5-3 months. Carnitine hydrochloride is administered intravenously drip at 5-10ml 20% solution, at 300-400 ml of physiological (isotonic) solution, the course of treatment is 8-12 administrations.

To eliminate bouts of dizziness during vertebro-basilar insufficiency, Betagistin has proven well. Betagistin is used for 8-16 mg 3 times a day. It is advisable to begin treatment with small doses of the drug, if necessary, gradually increasing them. Course treatment is long (2-3 months). In order to reduce the intensity of episodes of dizziness and concomitant symptoms (nausea, vomiting), Meklosin is prescribed in particular to the movement. The daily dose is variable and ranges from 25 to 100mg.

Forecast for the disease

The forecast of vertebro-basilar insufficiency is determined by the nature and severity of the main cardiovascular disease, the degree of damage to the vascular channel and the possibilities of ensuring the coating blood circulation of the brain.

The progressive narrowing of the arteries, persistent arterial hypertension in the absence of adequate therapy is the harbingers of a bad forecast. In such patients, there is a high risk of developing stroke or the formation of discirculatory encephalopathy with a persistent neurological deficit.

Satisfactory condition of the vascular brain system, adequately planned therapeutic tactics are associated with the relatively mild course of vertebro-basilar insufficiency and a favorable forecast.

Vertebro-basilar insufficiency develops due to the insolvency of blood vessels, blood supply brain. The decrease in blood flow in the vertebrate and the main arteries lead to a decrease in the nutrition of the nervous tissue, which is manifested by a violation of its functions. The clinical picture is largely reminiscent of other pathological conditions, since the symptoms are nonspecific. Diagnosis using instrumental methods allows you to confirm the vertebro-basal syndrome in 95% of cases. Treatment is effective even in patients with severe signs of LBN.

Show all

What is vertebro-basilar failure

Vertebro-basilar insufficiency is a reversible disease, which results in a partial loss of brain functions. This state leads the insufficiency of blood circulation of the nervous tissue. As a result, the nutritional cells are disrupted, after eliminating the cause, the functional properties of the central nervous system are returned completely.

In the medical literature you can meet synonyms of vertebro-basilar insufficiency, such as vertebral-basilar insufficiency, the syndrome of the vertebro-basilar arterial system, LBN. This pathological condition is characterized by a large number of violations, complaints from the patient similar to many other diseases, so hyperdiagnosis often occurs in practice. In the absence of additional research methods, the diagnosis is exhibited without any reason that is often unreasonable.



The reasons

The following causes of the development of vertebro-basilar failure are distinguished:

• stenosis (narrowing) of blood vessels - primarily an extracranial vertebrate department, connectible and nameless arteries are affected, which is due to the presence of atherosclerotic plaques in their lume;
• individual design features - anomalous extinguishing of vertebral arteries, their underdevelopment, pronounced apolosity, insufficient number of anastomoses (compounds);
• microangiopathy - arises against the background of other states, such as diabetes and arterial hypertension, due to insufficient blood supply in small brain arteries;
• pathological compression - is often caused by violations in the structure of related anatomical formations, for example, the staircase muscle, cervical vertebrae;
• traumatic lesions - appear as a result of injury of neck and head, after improper medical manipulations and non-accurant movements, when performing gymnastic exercises;
• inflammatory diseases - the arteries of the vessel wall lead to its edema, it becomes thickened, the lumen is narrowed;
• antiphospholipid syndrome - as a result of it, there is a violation of arteries, the risk of thrombosis arises, including young people.



Accompanying illnesses

The syndrome of vertebro-basilar arterial failure is more often developing against the background of other pathological conditions of the body. One of the most common is arterial hypertension, since under the condition that there is a constantly increased pressure in the vessel, the premature wear of the arterial wall occurs.

Often the LBN develops against the background of the cervical osteochondrosis. Degenerative-destructive changes in the cervical spine and in intervertebral discs, which can be provoked by spondylise and spondylolisthesis, violate the physiological blood flow due to the surveillance of the vertebral artery. The pathological formation of osteophytes of large sizes on cartilage tissue has compression on the vessels. Clinical manifestations can enhance when turning the head, which is due to a decrease in blood supply due to the change of the position of cartilage and bone structures.

Hormonal disorders, including diabetes, lead to the development of angiopathies. This syndrome implies a change in the structure of the vascular wall, which affects functioning. With these pathological conditions, the violation is observed not only in vertebral arteries, but also in the vessels of a smaller caliber.



Provoking factors

The development of vertebro-basilar insufficiency leads a number of reasons with which many people face everyday life. Among them are distinguished:

• change of blood properties, increase its viscosity;
• thromboembolic violations;
• fibrous muscle dysplasia;
• bundle of vessel walls;
• sedentary lifestyle;
• smoking and alcoholism;
• genetic predisposition;
• improper nutrition;
• chronic stress and long-term psycho-emotional stress.

Increased thrombosis and the presence of cloth thromboms in the lumen of the artery leads to more serious violations, up to the development of transient ischemic attacks. At the site of the pathological formation of the vessel, the formation of a thrombus.

Symptoms

All signs of vertebro-basilar insufficiency can be divided into temporary and constant. The first have a brief character, from several hours to 2-3 days. They occur with transient ischemic attacks, which are a manifestation of acute violation of cerebral circulation. This condition is characterized as crisis. A person is experiencing a gone pain in the occipital region, expressed discomfort in the neck and a strong dizziness.

When setting a clinical diagnosis, constant symptoms play a major role. As the pathological process progresses, they grow and are able to lead to stroke. A person notes dizziness that most often appear with a sharp change of body position and can provoke fainting. Heat pain wears a pressureful character, localized in the occipital region, while the patient feels nauseous, noise in the ears, partial decline in hearing, impairment of vision. Cognitive abilities are reduced, apathy appears, memory and attention will deteriorate, the person becomes scattered.

Among nonspecific symptoms, weakness is distinguished, which increases during the day and is most pronounced by night. Even a small amount of physical exercise leads to fatigue. We increase irritability and tachycardia, which leads to the development of internal anxiety and voltage growth. Some patients with vertebro-basilar syndrome celebrate increased sweating, the feeling of heat in the skin of the head and arms, the feeling of the foreign object in the throat, which leads to an attachment or rare dry cough.

Violation of motor activity is characterized by the emergence of central paresis and changes in coordination, which occurs after the brains and its structures. Patients have tremors of the hands, instability when walking, a decrease in muscle tone, and the process can be one-sided. Some areas of the upper and lower limbs lose sensitivity, it is observed in 25% of cases.

In case of malnutrition of the visual nerves, the loss of visual fields is developing, reduced perception of the color scheme. The impossibility of focusing on a certain subject, the flashes of flies in front of the eyes and the emergence of black dots talks about pathology in the visual center of the brain.

Among the gentle and pharyngeal symptoms, there is a perfense in the throat, difficult to pass the passage of the edible lump, the appearance of spasms and feelings of the foreign body in the throat. A person periodically complains of a rare dry cough and witnessing voice. These symptoms appear without inflammatory processes, which indicates their neurogenic origin.

Of particular importance is dizziness. It is systematic nature, there is a tendency to periodic extinction. This is explained by the fact that during vertebro-basilar insufficiency, the peripheral and central departments of the vestibular apparatus suffer. Dizziness in this case is the initial manifestation, with the development of the LBN, the person is inclined to psychiatric diseases.

Diagnostic features

Despite the fact that clinical manifestations are non-specific, with the help of instrumental examination methods, in most cases, it is possible to confirm the vertebro-basal syndrome. The most affordable way is ultrasound doppler. This study displays the permeability of the arteries, the rate of blood flow and the uniformity of blood distribution by vessels. In duplex scanning, the wall structure is viewed.

Among the high-precision diagnostic methods, magnetic resonance tomography occupies a key value. With the help of special programs and layer-by-layer sections in 3 projections, you can create a visual image of the location of all vessels with places of their pathological narrowings and extensions. By means of MRI, even small foci of blood flow disorders are defined. Machines with a capacity of more than 1.5 Tesla allow you to see small blood clots with a size of less than 5 mm.



Angiography at MRI Head and Neck Vessels

Treatment

Treatment of vertebro-basilar insufficiency is carried out only after a qualified full examination and confirmation of this diagnosis. Tactics largely depends on the cause and degree of prevalence of the process. Along with the main activities aimed at eliminating provoking factors, symptomatic therapy is carried out, which allows you to improve the quality of life and reduce the associated manifestations.

Patients with a diagnosis of LBN need to conduct total control over the level of blood pressure, adhere to a special medical diet, which implies a reduction in salt consumption, carbohydrates, fast food products, smoked, canned food. It is recommended to refuse fat and fried foods, the daily diet should consist mainly of lean dishes and soups.

Every day you need to use fresh vegetables and fruits, among which the greatest preference is given to citrus, Bulgarian peppers, acidic varieties of berries. Of dairy products, special value is a special value. The trace elements needed to cure vascular pathology are in seafood.

A person needs to spend more time on the fresh air every day, to observe the mode of work and recreation, limit nervous emotional tension. It is important to abandon smoking and drinking alcoholic beverages. At the initial stages of the development of LBN, treatment is limited to this, after a month there is a significant improvement in well-being. If this did not happen, the reception of drugs and visits to the physiotherapy office is recommended.

Medical therapy

Treatment with drugs is carried out outpatient or in hospital, which is due to pronounced clinical manifestations. The following groups of funds are assigned:

• vasodilators (vasodilators) - due to expanding the enlightenment of vessels, blood flow resumes and the nutrition of the central nervous system is normalized;
• antiagregants - improve the properties of blood due to its discharge and reduction of the risk of thrombosis;
• nootrops - glycine, piracetam, actovegin, cerebrolysin enhance the brain functions;
• hypotensive remedies - reduce blood pressure, provided constant hypertension calculated on regular reception, dosage and groups of drugs are selected individually for each patient.

Antiemetic and painkillers are prescribed for the removal of symptoms. If there are pronounced psychogenic disorders, it is recommended a course reception of antidepressants, sedative, sleeping pills. Their appointment requires mandatory control by the doctor, since otherwise undesirable consequences may arise.

Operational treatment

Operational intervention is carried out in extreme cases, which are due to the severe course of the pathological process. Most often, the indication is the persistent insufficiency of blood circulation, associated with a decrease in the diameter of the arterial lumen. This is observed in spasms and stenoses, as well as in the compression of anatomical formations. Examples are metastasis, primary oncological process, deformation of the spinal column after injuries.

Angioplasty implies the use of special stents that increase the clearance of the vessel and normalize its permeability. With pronounced atherosclerosis, when the vessel is determined by the cholesterol of a large size, its excision is carried out, as a result of which physiological blood flow is normalized. To stabilize the spine carry out reconstructive operations, implying the correction of intervertebral discs and bodies of the vertebrae.

Auxiliary and supporting therapy

Given that in most cases, other diseases of the body lead to vertebro-basilar insufficiency, such as osteochondrosis, it requires constant performance of some medical manipulations and maintaining overall health. A good effect can be achieved with manual therapy, a cerhing and collar zone massage, needleflexotherapy. Thus, the load on the spine is reduced, the blood supply to muscles and joints is improved, the compression of the arteries decreases.

Hirudotherapy (leech treatment) has a proven expressed effect with all diseases of the cardiovascular system. Patients are advised to regularly perform a certain set of exercises, the technique of the shosin is most often used. In order to reduce the muscle tone and the treatment of osteochondrosis, the use of a collar of Shazz is justified. Courses are prescribed vitamin complexes and visits to physiotherapy procedures, among which magnetotherapy and electromostimulation plays a special role.

Alternative medicine

Treatment of vertebro-basilar insufficiency by folk remedies has widespread. Many plants and foods have good soothing, anti-inflammatory, vasodilators and other properties. Vitamin C, which is contained in large quantities in citrus, cranberries, sea buckthorn, currant, has a pronounced bloodboring effect that minimizes the risk of thrombosis. The listed products must be present in the daily diet, since the body does not create the endogenous reserve of this trace element.

Garlic, lemon juice and honey will help reduce the symptoms of manifestation. For the preparation of the means you will need 3 cloves of garlic, which is thoroughly crushed with a grater or blender. The resulting substance must be placed in the glass container with a lid and remove in a dark place for 3-4 days. The garlic juice is pressed and mixed in the same proportions with lemon, after which 1 tsp. L. Honey. You can use the tool in 1 tbsp. l. For night for 14 days.

Vertebro-basilar insufficiency (LBN) is a deterioration in the work of the brain, due to the wrong and weak blood supply.

The basil vessel is the central artery of the entire body of the brain, which is suitable for other vessels, ensuring the vital activity of this body and its proper functioning.

If the blood flow is incorrect operation in the basilar artery, a sufficient amount of essential substances does not come to the brain cells, which causes basilar insufficiency and violations in the work of the nervous system centers (vegeto-vascular dystonia).

Code of ICD 10

According to the international classification of diseases of the tenth revision of the ICD-10 - vertebro-basilar failure refers to the class G45.0, the "Vertebro-Basilar arterial system" syndrome.

Bleeding brain, what is it?

The arteries that feed the cells of the brain, follow the path from the branch of the nameless vessel the right side of the human body, as well as a branch from the vessel in the region of the clavicle. These two artery through the spine rise to the brain, where they arise their fusion in cells.

This is how basal artery is formed, passing throughout the lower part of the brain body. The vertebobasilar pool includes 30.0% of the brain surface.

With a lack of blood from entering the brain, through its main artery, there is disorders in the delivery of the power centers and deviations from the normal functioning.

The centers of the brain, which supply the bio-liquid vertebobasilar arterial system:

• Middle brain department;
• The oblong type of brain department;
• Hypothalamus;
• Department of the cervical part of the spinal cord cells;
• The occipital brain department;
• Shares of the Dump Department;
• Hemisphere of the brain of the temporal area;
• Region of the optic bulb;
• Brain Department - Varoliev Bridge;
• Cerebellum;
• Talamus Department.

More than 70.0% of ischemic attacks of a transient character is a violation of the blood supply to the brain departments, hypoxia brain and brain microinsults. All these pathologies occur in the basin of Vertebrobasilar.

The consequences occurring in this brain department are developing a stroke of ischemic character in 35.0% of patients.

Fatal outcomes from strokes that occur in the back of the brain are three times more than mortality in a stroke of a carotid artery.

What doctor treats Vertebro-Basilar Syndrome?

The therapy of the vertebrobasilar syndrome and its insufficiency is considering doctors-neurologists. If the syndrome acted a complicated stroke shape, then the treatment is developing surgeons of the vascular direction.

Also, with the development of pathology, there are related diseases, then profile doctors are connected to therapy:

• Dr. Olenrologist;
• Cardiologist;
• Manual therapy specialist;
• Ophthalmologist;
• Physiotherapist.

Etiology

The prospectors of the vertebro-basilar syndrome and its insufficiency a large number.

Common causes of pathology:

• Genetic hereditary leaning to the pathologies of the vertebobasilar arterial system. These pathologies include congenital deviations in the structure of the body vessels system;
• Congenital pathology anomaly kimmerley;
• Genetic disease hypoplasia of the arteries of the spine;
• Injury to the spine of the neck area;
• Inflammatory processes in the walls of blood vessels;
• Disease such as
• Atherosclerosis of large arteries;
• Atherosclerotic plaques at basic artery;
• Arterial stenosis;
• Pathology of the endocrine system - diabetes mellitus. Brain vessels are affected with a small diameter;
• The chronic stage of arterial hypertension;
• Antiphospholipid type syndrome. The presence of thrombosis elevated in the arteries, as well as disturbed clearance inside the arteries, which prevents good blood flow in them;
• The bundle of cells of the walls of vertebro-basilar vessels and in the placement places is biological fluid (blood);
• Vertebral vessel thrombing;
• Thrombosis in the Basilar vessel;
• Transmission of the hernia of the basilar artery, which leads to a violation in the bloodstream;
• Pathology spondylolisthesis (spondyleze);
• Oncological neoplasms in spinal cord cells;
• Malignant formation of spinal bones, or metastasis in the spine, cancer cells during diseases of other organs.

The progression of the disease leads to the manifestation of additional symptoms

Vertobazilar insufficiency is expressed in the symptoms of dependence on the deficit area in the blood flow system:

common symptoms	rarely encountered symptoms
· Head circles, constant and strong - in 80.0% of patients with LBN;	· Violations in the audience nerve;
· Sweetness in motion - 70.0%;	· Feeling of clogging of the eyeball;
· Instability when walking - 70.0 - 80.0%;	· Split items before your eyes;
· Loss of equilibrium - up to 80.0% of patients%	· Flicker of dark spots;
· Noise in the ears - 60.0%	· Reduced concentration on objects;
· Head pain, sometimes strong in the occipital region - more than 55.0%;	· Do not care;
· Reduced hearing quality - up to 40.0%;	· Scattering;
· Nausea, periodically strong, which can provoke a vomit syndrome - 30.0%.	· Reduced memory;
	· Weakness of the body;
	· Fast fatigue;
	· Irritability; feeling pity for yourself;
	· Increased plasticity;
	· Increased Pot - hyperhydrosis;
	· The rapid reduction of the heart muscle is sinus tachycardia.

Symptoms of ischemic transient type attack

Symptoms of this attack with bright manifestations, but these manifestations have a short time interval and by the time of the arrival of the brigade of the ambulance medians, their severity is very often erased, therefore, the preliminary diagnosis of ischemic attack of the transient type, the doctors are installed on residual features.

Symptom of transient attack at vertebro-basilar failure:

• Problems with the speech apparatus consequence of numbness of the oral cavity, lips and language;
• Difficulty in swallowing;
• Difficult breathing (lack of air in lungs) - shortness of breath;
• The attack on the lower limbs is a sudden immobility, one6 of the limbs, the impossibility of standing on the legs (fall), a faint condition;
• Loss of vision for a certain time interval;
• Loss of orientation on the ground;
• The inability to perceive human speech;
• Disorientation;
• Tremor hands;
• Convulsive cuts of the body and his shake;
• Trembling in the lower limbs;
• Limited in the movements of the liquids of the body;
• Numbness of body part.

Transient attack during vertebro-basilar insufficiency provokes a stroke of ischemic type. What pills to drink, and what course of therapy after an attack?

Treatment of transient attack Good effect give mexidol tablets.

A course of drug therapy with this drug - up to 6 calendar weeks.

With incorrect treatment for vertebro-basilar insufficiency, or at all the treatment of this pathology syndrome, after the first experienced transient attack, even in a light form, for 5 calendar years there is a ischemic type of stroke and in most cases the result of its development becomes a fatal outcome.

Vertebro Basilar Syndrome in Children

Prior to the study of the pathology of the verticazilar syndrome, it was believed that the development of vertebro-basilar insufficiency is possible only in an adult organism. But now experts found that this type of insufficiency may occur in childhood. Its manifestations from 3 calendar years have been marked.

Scientists came to the conclusion that the development of vertebro-basilar insufficiency in the children's body has the root cause of abnormal congenital pathologies of the Basilar artery, as well as spine vessels.

In the early childhood injury in the early childhood, also leads to the emergence of vertebobasilar syndrome.

Symptoms and signs in children such:

• Fast and excessive fatigue of the child;
• Restless behavior;
• Permanent crying;
• Duckless drowsiness;
• Violated posture when walking and at the seat;
• The inability to be in a stuffy room is a lack of air, which provokes a strong head circling, in which a faint condition is often.

Vertebro-basilar insufficiency is quite poorly a diagnostic study, because its manifestations occur in different ways. Vertebrobasilar symptoms can be confused with symptoms of other pathologies in the body.

Children are very important to establish the correct diagnosis, which is confirmed by decoding the clinical laboratory, as well as the results of instrumental techniques in the diagnosis of vertebro-basilar insufficiency.

Diagnostics

To estimate the degree of damage to the nervous system with vertebro-basilar failure, functional types of samples are carried out:

• Testing muscle tone;
• Sample with the method of hyperventilation - for this sample, symptoms are recognized at fast and frequent inhales;
• Sample to determine the degree of dizziness. This sample is carried out by a sharp and rapid movement of the head. Head turns occur alternately on the right side, then to the left side. Or turns the tricks, but the head remains fixed;
• Dr. Klein's test - This technique helps to identify the characteristic symptoms with a sharp thumbnail of the head back by 15 degrees. Such symptoms are revealed as - disorientation in space, the inability to focus on the human voice and perceive information, as well as the suspension of the pupils of the eyes and the difficulty in responding to simple questions;
• Testing of vertebro-basilar insufficiency by the Hountan method is a sample for equilibrium (vestibular). It is necessary to stretch with closed eyes and hands to stretch ahead, turn the head in the direction of the body to failure. So to simultane up to 30 seconds. Then do in the other direction. If the equilibrium has not changed, and their hands remained upwards, then the brain barrel is not amazed.

Clinical laboratory tests for vertebral-basilar insufficiency:

• General blood analysis;
• Analysis on an indicator of electrolyte composition;
• Blood on sugar;
• Biochemical analysis for cholesterol - lipid analysis;
• Biochemistry - coagulogram;
• Biochemistry - hemostasiogram;
• Indicator of phospholipids and their antibodies.

Instrumental diagnostics

To install an accurate diagnosis, sometimes not enough clinical laboratory decodes and testing, because it is necessary to find the root cause of pathology and put the correct diagnosis.

The following techniques are applied to study vertebro-basilar insufficiency:

• Doppler with ultrasound waves. With this diagnosis, the blood pressure is estimated when driving in the blood flow system. Installed blood flow;
• Angiography of vertebro-basilar insufficiency. This technique implies an input in the artery that the contrast substance is investigated. With this method, an instrumental check of the condition of the shells of the arteries, the wall thickness and the maximum lumen of the test vessels are occurring;
• X-ray spinal column. X-ray evaluates the state of the spine and determines the possible deviations in it;
• Computed tomography (CT). Methods for determining the state of the vessels, as well as the spine;
• Magnetic resonance technique (MRI) is the ideal method for identifying neoplasms in the spine, as well as identifying vertebral hernia;
• Infrared thermography. Study of organs and blood flow systems according to the method of thermal estimation;
• Methods Reoeczephalography. This technique makes it possible to assess the condition of blood flow in the brain;
• Angiography magnetic resonance (MR) vertebro-basilar insufficiency. This procedure is carried out for the study of the bed of all arteries of the brain.

Magnetic resonant angiography of vertebro-basilar insufficiency

Differential type

Vertebro-Basilar pathology is similar to symptoms with other diseases:

• Labyrinth in the acute stage of development of the disease;
• Sclerosis of multiple-type;
• Meniery disease;
• Pathology of the neurinoma of the nerve of the auditory body;
• Psyche or neurosis disorders;
• Disease vestibular type of neuronit.

When sclerosis of multiple-type sclerosis, there are no deviations in the hearing organs. Dizziness occur much longer in time.

With the disease of Meniere, patients have a strong dizziness, but the diagnosis shows that there are no violations in the body of the organism vessels.

With an unstable stage of the vestibular apparatus, a strong dizziness occurs with a sharp change of the position of the head, or when changing the position of the body.

With a sharp rise from bed. In the elderly, many suffer from such pathology. Only the reason is not in the vascular system, but in a weak vestibular apparatus, and in the problems of the spine.

Most often, such dizziness occurs on the background of the cervical osteochondrosis.

With psychological disorders and diseases of neurology, turbidity in the head, nausea, and also instructs in a long road. This symptomatology is not similar to LBN. If diseases proceed at the same time, then the symptoms will be washed away.

Is it possible to cure a vertebro-basilar arterial system syndrome?

Pathology Vertographan, how to treat? Determining the symptoms, and the treatment is appointed suitable for this established diagnosis.

At the crision of the acute stage of vertebro-basilar insufficiency, the patient has a bed in the hospital, in order for the patient during the period of medical treatment, the patient is constantly under the supervision of medical personnel. Monitoring the patient's condition will help prevent the consequences of this crisis - stroke.

Chronic disease of the circulatory disorder, which proceeds in the light stage - to be treated outpatient.

For the treatment of vertebro-basilar insufficiency, drug treatment is used with physiotherapeutic treatment, to strengthen the therapeutic effect.

The medication course of therapy is prescribed by the doctor individually, because there is no standard treatment in medicine on vertebral disorders.

Some drug drugs are not treated, therefore, physiotherapy techniques are also included in the complex treatment of this therapy, and treatment with the means of traditional medicine, as well as therapeutic gymnastics (LFC).

With severe pathology, surgical interference resorts.

Medicia treatment

Preparations that are appointed for the treatment of vertebro-basilar failure:

• A group of vasculating medicines (vasodilators). These medical devices warn occlusion. Data drugs chronic syndrome of vertebro-basilar insufficiency are treated in spring, or at the beginning of autumn. The dosage is appointed minimum, and according to the prescribed diagram of the drug course it increases. If for therapy, there is no positive effect on the body, the drug is replaced by another medicine;
• A group of antiagregants - reduce the coagulation capacity of blood plasma. This group of drugs is used to reduce the risk of blood cloves in the Basilar vessel. The drug from the Antiagregant group is aspirin, which, with a vertebasilar syndrome, must be taken daily. In pathologies of the digestive tract, aspirin is accepted after eating, and it is forbidden to consume on an empty stomach. If aspirin does not have a positive effect on the coagulation process in the body, then it is replaced by antiagregants - dipyridamol, or the drug Tiklopidine;
• Group of metabolic and neoplastic drugs. These drugs are intended to improve the functional abilities of all brain departments during vertebro-basilar insufficiency. These drugs include: piracetam, medication agent Aktovegin, nootropic drug cerebrolysin, Sexax medicine;
• Group Antihypertensive preparations. This group of drugs is designed to control the arterial pressure index. With vertebro-basilar insufficiency, the pressure adhesion is high, therefore, with medication therapy, this group of drugs is included in the list of mandatory;
• Preparations that, with this syndrome, remove the basic symptoms - painkillers, dosage tools of a sleeping recycling;
• Antidepressants are prescribed for the removal of symptoms of strong circulation of the head, and anti-ansulistic drugs, if nausea, when dizz, causes a vomit reaction.

Surgical methods

With a severe stage of vertebro-basilar failure, when drug therapy does not show effect in treatment, the method of operational treatment of the vertebro-basilar system of vessels is applied.

Methods of operational correction of the vascular basilar brain system:

• The method of surgical correction is the microdiskectomy of the spine. Means the removal of hernias between the vertebrae and the stabilization of the function of the spine. This operation refers to the category of neurosurgical intervention, and is performed by a doctor - neurosurgeon;
• Methods of laser adjustment of the state of the discs between the vertebrae;
• Endartretectomy technique is a method for removing cholesterol atherosclerotic plaques inside the artery. This technique allows you to improve the bleeding removal of plaques and an increase in the lumen inside the artery;
• Basilar artery angioplasty. This technique allows you to insert a stand in the vertebrate vessel, which prevents the evidence of this part of the artery. The extension of the vessel provides normal blood flow in the cerebral circulation system;
• In arterial stenosis, a stenting technique is used - this is a method through an arteries (aneurysmism parameter) of the thigh and through a femoral vessel is introduced to the place of destruction of the aorta. When the stand arrives at the place of the defect, revealing, it strengthens the wall of the affected part of the artery from the inside, and thereby prevents its gap.

Stinting technique

Physiotherapy

For the treatment of vertebro-basilar insufficiency, there are several techniques of physiotherapy:

• Therapeutic recovery massage - improves blood flow to the brain. The spine massage is used completely, and also applied in separate parts of the body: the thoracic massage on the spine, the neck massage, the massage of the head, to increase blood circulation in it;
• LFK is a healing physical consumer complex. In the systematic use of exercises, the exercise of therapy can be improved by the back of the back. Also, exercises strengthen all spinal departments, as well as remove muscle spasms;
• Manual reducing therapy for vertebro-basilar insufficiency - helps to restore all the functions of the spine, as well as blood flow systems;
• Hirudotherapy Methodology - therapeutic process of vertebro-basilar insufficiency with leeches helps restore vascular disorders and pathology. Hirudotherapy reduces blood pressure index;
• The method of treatment is reflexotherapy. This method involves using acupuncture in therapy. With this method, muscle spasms are removed, which improves the blood supply to the brain. It is especially effective to use this method in osteochondrosis of the cervical department;
• The method of physiotherapy for vertebro-basilar insufficiency - magnetotherapy;
• Wearing the therapeutic corset courses on the neck. When injuries of cervical vertebrae, this method is simply necessary for effective rehabilitation.

Treatment with folk remedies

Recipes of folk healers help as an aid in medication therapy for vertebro-basilar insufficiency. This technique of traditional medicine can only strengthen the therapeutic effect of treatment, but not to replace medication therapy.

Alone folk remedies of the syndrome of the vertebro-basilar arterial system are not cured, and the time missed in treatment only will aggravate the syndrome of vertebro-basilar insufficiency, which will lead to irreversible processes in the blood flow system, as well as in the brain departments.

It threatens an attack of ischemic stroke, which often ends with death.

For blood diversion and preventing vessel prevention, such drug plants are used, in which the high content of vitamin C:

• Lemon and lemon juice. 0.5 lemon juice add to 2000 millilita water and drink this water. To drink in one day. The next day to make a new drink;
• Orange and Fresh from Orange. 200 milliliters per day will help prevent thrombosis;
• Currant berries. There are berries in any form - fresh, frozen, compote from currant;
• Malina is not only an anticoagulant, but also a beautiful plant to strengthen immunity;
• Rosehip. Rosehip fruits are a leader in the number of vitamin C. Good anticoagulant, but it is not necessary to take it in a large number, because it has diuretic actions;
• Also, a good anticoagulant - kiwi, berries, grapes, fruits, and tomatoes;
• Garlic is a plant that will help the blood dilution. Recipe: 3 Large heads of garlic Estropy in a blender (or with a meat grinder). Fold into the glass jar and hide in a dark place for 3 calendar days. After this time, it is necessary to strain this mixture, and add lemon juice and natural honey to it. All in equal proportions. Take 1 spoon before bedtime. Medical course, this means - 30 calendar days;
• Vasasculating recipe for healing herbs at vertebro-basilar insufficiency: the fruits of the plant hawthorn (20.0 grams), pour 200.0 milliliters of boiling water and peak on a steam room for 5 minutes. 30 minutes to insist in a bought form and after filtering take one spoon before meals in 20 - 30 minutes. The course of therapy is at least 30 calendar days.

Gymnastics

Therapeutic gymnastics for vertebro-basilar failure is done constantly, without multi-day courses. It can be applied both as a disease prevention. All movements are made smoothly and not through force. At a slow pace, smooth breathing.

Exercises of gymnastics with basilar syndrome:

• Stand exactly, leg socks bring together, working your head - bending your head forward and you need to get a chin to chest. Stand in this position 5-7 seconds and take the original position. The frequency of repetitions is 10 times. Also perform exercises with your head in one side 10 times and in the other side 10 times;
• Scalp can only be done after performing the first exercise. Slow rotation of the head in the direction of the shooters in the clock, after that, against the direction of the watch arrows. Also this exercise is made 10 times;
• Exercise for the neck - pull the head forward. To stand in this position no more than 5 seconds and return to the original position. And so 10 times;
• Further, the set of exercises for the body. Turns of the body in the right side, then on the left side. Each turn is carried out 10 times;
• At the end of the Gymnastic Complex work with legs. Raise the leg and stand on one leg - at least 5 seconds. It is being worked out alternately and left leg 10 times each.

Preventive actions

With vertebro-basilar insufficiency, it is necessary to prevent elementary life rules in order to prevent:

• Adhere to balanced nutrition and more to eat products that have an anti-thrombied blood plasma effect - greens, vegetables (especially tomatoes), citrus fruits, and all berries. Sea products and fat fish (omega 3), cottage cheese;
• Get rid of dependence - alcohol and nicotine;
• To use no more than 5 grams of salt for one calendar day;
• Do not overload the body;
• Systematically measure the pressure index and adjust it;
• Move more;
• Walks in the open air;
• Do not be nervous;
• Well in the prevention measures to do swimming;
• We systematically attend the doctors and undergo prophylactic diagnostics.

Forecast

With timely qualified therapy of vertebro-basilar insufficiency and with constant correction of the blood flow system - the forecast is favorable.

With the untimely diagnosis of vertebro-basilar insufficiency and treatment of the syndrome of the vertebro-basilar arterial system, it provokes a stroke, as well as discirculatory encephalopathy - the forecast is unfavorable.

The vertebral artery is located on the back of the spine and merging with the vertebral artery of the opposite side forms a basilar artery. These arteries supply blood, oxygen and nutrients to vital structures of the brain, such as brain barrel, occipital shares and cerebellum. Circulatory disorder in the above pool and is called vertebobasilar failure.

The condition referred to as atherosclerosis reduces or stops the blood flow through the vertebrobasilar system. Atherosclerosis is characterized by narrowing and blockage of arteries due to cholesterol deposit. More information about this: a raid, which consists of cholesterol and calcium accumulates in your arteries, narrowing their lumen, form cholesterol plaques, and as a result, the influx of blood to the brain is reduced. Cholesterol plaques can completely block the blood flow in the artery causing their absolute stenosis, which can cause a stroke. This can happen in any artery in your body. When this happens in the arteries of your vertebobasilar system, it reduces blood flow to the structures in the back of your brain. This condition is known as Vertebrobasilar Insufficiency (LBN).

What causes LBN?

The syndrome of vertebarian insufficiency occurs when the blood flow to the back of your brain decreases or stops. It is known that atherosclerosis is the most common cause of the disease. In turn, the cervical osteochondrosis, the features of the development of blood vessels of the Vertebobasilar basin, are playing an important etiological role: Aplasias and gypoplasia of the vertebral arteries or the main arteries, their pathological move (convolutions).

Who risks to purchase vertebobasilar failure syndrome?

RISK RISK RISKS are similar to those related to the development of atherosclerosis. These include:

• smoking
• high arterial pressure (hypertension)
• diabetes
• obesity
• age older than 50 years
• family history
• increased content of lipids in the blood (known as hyperlipidemia, dislipidemia)

People who suffering from atherosclerosis or peripheral arterial diseases also have an increased risk of developing vertebarian insufficiency.

What are the symptoms of vertebro-basilar failure?

Symptoms vary depending on the severity of the state. Some symptoms can last within a few minutes, and some of them can become permanent. Common symptoms of vertebasilar failure include:

• Loss or worsening vision in one or both eyes
• Twist in the eyes
• dizziness (Vertigo)
• numbness or tingling in the hands or legs
• nausea and vomit
• insensitive speech
• changes in mental state, including sometimes confusion of consciousness
• sudden, severe weakness in the whole body, which is called Drop Attack
• loss of equilibrium and coordination of movements
• difficulty swallowing
• weakness in any limb

Symptoms of acute vertebobasilar failure Similar to stroke. Contact emergency medical help if you experience these symptoms. Immediate medical intervention will help increase your chances of recovery if these symptoms are a stroke result.

Diagnosis of LBN?

Your doctor will hold an objective neurological inspection, asks you about your chronic diseases and may in some cases assign:

• CT or MRI, duplex scanning BTSS
• magnetic resonance angiography (MRA)
• blood test, coagulogram
• echocardiography
• in rare cases, the hospital doctor may also assign a spinal puncture.

A leading role in the diagnosis of MRC in the WBB is currently MRI and CT and also. In the diagnosis of vertebobasilar failure, it is necessary to take into account that the symptoms of the disease are often not specific and may be a consequence of another neurological or other pathology, which requires careful collection of patient's staining, studying the history of the disease, physical and instrumental examinations to identify the main reason for its occurrence.

There are vascular vessels of the brain and the Weszov of the neck of the neck. Often they are held together, it creates a holistic idea of \u200b\u200bblood supply vessels with blood. The technique includes a study of carotid arteries, connectible and vertebral arteries, veins of the neck, as well as the main arteries of the brain.

The image during ultrasound studies of the head and neck vessels is obtained due to the fact that ultrasonic waves emitted by special ultrasound sensors passing through the blood vessel, differ differently from erythrocyte cells, depending on the direction and speed of blood flow. Reflected waves are captured by an ultrasonic sensor and, after converting electrical pulses are displayed on a monitor in real time in the form of graphs and color photographs, which represent blood flow through blood vessels. The USDG vessels allows you to see in real time the vessels "from the inside" and "outside", thereby giving the opportunity to determine the changes in blood flow in vessels associated with spasm, narrowing or thrombosis.

During dopplerography Only one function can be studied - vessel passability, clarify the degree of occlusion in% in addition ultrasonic duplex vascular scanning (RSS), allows you to estimate two functions at the same time - to investigate the vessel structure and evaluate the rate of blood flow, and ultrasonic Triplex scanning - Study of three functions:

• study of the structure of vessels;
• rate blood flow
• accurate assessment of vessels in colors.

Magnetic resonance angiography - Mra

Mra or magnetic resonance angiography is an informative and safe method of radiation diagnosis that does not use X-ray radiation allows the 3rd picture of the vascular channel of the brain.

This study makes it possible to assign appropriate treatment in a timely manner and, thus, improving the forecast of the disease, also, on the basis of MRA data, a preoperative examination can be carried out in case of stenting or angioplasty.
With the help of MP angiography diagnose:

• aneurysms and pathological recesses;
• stenosis and occlusion of vessels;
• vascular malformations;
• atherosclerotic changes of the neck and brain arteries.

MR Angiography of the arteries of the brain is carried out without contrast - this is an undoubted advantage.

To clarify the level and degree of damage to auditory paths, a study of auditory caused potentials is prescribed. Consultation of ENT, Surdian, the audiogram is prescribed for the purpose of differential diagnosis.
MRI of the cervical spine with the aim of vertebrogenic effects on the vertebral artery.

Treatment of vertebrobasilar failure

• quit smoking if you smoke
• changing a diet, in order to control blood cholesterol
• weight loss if you are overweight or obesity
• more movable lifestyle, physical education

In addition, your doctor can prescribe medicines to help reduce the risk of stroke, the severity of the effects of chronic brain ischemia in BBB. In the case of the presence of a sampling of the head, high probability of thrombosis or embolism, the risk of re-stroke in patients who have undergone a transient ischemic attack in WBB, prevention measures are used that eliminate existing risk factors.

• These drugs are aimed at:
• control over blood sugar
• reduced blood cholesterol
• improving blood circulation
• reducing blood clotting

In the case of an acute neurological deficit, alternating syndromes, cerebellar insufficiency, negative cattle, the patient should be hospitalized in the vascular center of them a neurological department to exclude stroke in BBB.

According to the most effective preparations for the secondary prevention of ischemic stroke:

• acetylsalicylic acid
• dipyridamol.
• ikopidine
• kuraltil
• clopidogrel.

The gold standard of stroke prevention to date remains aspirin in a dose of 75-150 mg / day.

Chronic vertebro-basilar insufficiency is often accompanied by elevated cholesterol and (or) dyslipidemia, may occur atherosclerosis of basilar or vertebrate arteries. In this situation, given the level of cholesterol,% of the stenosis of the arteries of the vertebobasilar basin and carotid arteries, concomitant pathology may be raised about the need for the appointment of statins, such as atorvastatin at a dose of 10 mg / day. LDL per 1.0 mmol / l leads to a decrease in the risk of all strokes by 10%, and by 1.8 mmol / l - by 17%. In general, according to a number of studies, the use of statins for 3-5 years allows to reduce the risk of stroke for 24-36% with chronic LBN.
Medical physical culture and moderate physical activity significantly reduces the risk of cardiovascular diseases and stroke statistically noted that people with moderate or high activity have a lower stroke frequency compared to people suffering the state of hypodynamia. Moreover, moderate physical activity helps reduce the risk in men and women by 20%, high physical exertion - by 27%. This occurs due to the fact that a tendency to reduce the arterial pressure and body weight is formed, blood vessels are expanding, the tolerance of glucose is improved.

Correction of oxidant stress and neurometabolic therapy at VBN

Treatment of vertebrobasilar insufficiency with mexidol. Mexidol consists of two connected and functionally significant compounds: 2-ethyl-b-methyl-s-hydroxypyridine and succinic acid. The presence of 3-hydroxypyridine in the structure of the mexidol provides a complex of its antioxidant and membrane and membrane effects, the ability to reduce glutamate cytotoxicity, regulate the functioning of receptors, which fundamentally distinguishes mexidol from other drugs containing succinic acid.
The presence of succinate in the mexidol structure distinguishes it from Emoxipin and other 3-oxypyridine derivatives, since the succinate is functionally significant for many processes occurring in the body and, in particular, is a substrate to increase the energy exchange in the cell. The combination of the mexidol structure of two compounds with the necessary properties provides its good permeability through the hematorecephalic barrier, high soapiness and impact on various targets, consequence of the effect of the drug effects and high therapeutic potential. Mexidol is appointed by 500 mg / day parenterally 2 weeks, followed by a transition to a tableted firm at 125-250 mg (1-2 tab.) 3 times a day for at least 1 month. In addition, neurometabolic preparations are used glatchin, neuromidine, Combilipin.

A drug with antihypoxic effect cytooflavin is used

Against the complex of complex treatment of patients with vertebobasilar insufficiency, the use of cytooflavin is noted positive dynamics of clinical symptoms: dizziness, visual disorders, cefalic syndrome. It is characterized by accelerated in comparison with traditional methods of therapy with the pace of normalization. Citooflavin has regulating effect on
Peripheral circulatory resistance in vertebral arteries, vasomotor reactivity in the main artery, which indicates the improvement of cerebrovascular reactivity and increasing the compensatory possibilities of blood flow in the BBB of the pool.

It is significant correction of blood pressure, disaggregative therapy for various heart rate disorders.

Surgical treatment of vertebro-basilar failure

In some cases, the doctor may recommend the consultation of an angiohurgeon, which can assign an operation to restore blood flow in the back of the brain. Shunting or endarterectomy as options. Enhotrectomy is the removal of atherosclerotic plaque from the affected artery.

With stenping cerebral atherosclerosis, in the case of critical stenosis of the arteries, the following surgical interventions are carried out:

• angioplasty relevant vessels
• stenting the corresponding vessels
• endarterectomy
• the imposition of extracranial and intracranial anastomoses.

Prevention of LBN?

Sometimes the disease cannot be prevented. It may be in the elderly, who have previously suffered a stroke. Nevertheless, there are measures that reduce the development of atherosclerosis and LBN.

These include:

• to give up smoking
• control of blood pressure
• control blood sugar levels
• compliance with a healthy diet, which is rich in fruit, vegetables, solid grain products
• physical activity

What is the long-term perspective for the disease?

The prediction depends on your current symptoms, the state of somatic health and age. Younger patients experiencing light symptoms of vertebarian failure can control them by changing the lifestyle and drug therapy, as a rule, have a good forecast. Advanced age, weakened organism, and chronic accompanying diseases may adversely affect the pathological process. Discuss the tactics of treatment and medicine with a doctor to help prevent LBN or reduce its symptoms.

Vertebro-basilar insufficiency (LBN) is one of the most common causes of vestibular syndrome in elderly patients. The problem is caused by ischemia of the brain barrel, beginning suddenly, often after dehydration or decompensation of blood pressure. The disease is often accompanied by other symptoms (dysarthria, diplopia, ataxia limbs), but dizziness may be isolated manifestation. LBN is a transient ischemic stroke in a vertebro-basilar basin, symptoms disappear within 24 hours (usually within 1-2 hours), but can be repeated after a short time. Therefore, the disease is a warning of an impending infarction, stroke. The etiology often applies embolistic or thrombotic arterial stenosis of the vertebro-basilar basin. Less frequent causes - compression a. VERTEBRALIS with degenerative changes in the cervical spine, hemodynamic disorders.

Definition of the term

The syndrome of vertebro-basilar insufficiency, with the correct use of this term, is synonymous with OMK - acute violation of the cerebral circulation and TIA - transient ischemic attack. Tia is a clinical syndrome, which is a sign of a sudden temporary loss of a brain function or violation of vision in one eye, where the symptom corresponds to the territory of one vascular system, completely passes throughout the day. The start of symptoms is fast, the duration of vertebro-basilar insufficiency is a few minutes, about 2/3 patients manifestations completely disappear within an hour, the longest duration is 24 hours.

From the point of view of accurate terminology, instead of fuzzy definition of the LBN, the term of TIA or stroke in the vertebro-basilar basin is more appropriate.

LBN - diagnosis in neurology, having code in MKB-10: G00-G99 - CNS sickness → G40-G47 - parole disorders → G45 - transient cerebrovascular ischemic seizures and similar syndromes → G45.0 - a vertebro-basilar arterial syndrome.

Clinical picture

The clinic (symptoms) arising in the ischemia of the vertebro-basilar basin can be very diverse. A common feature - dizziness - is often accompanied by nausea, vomiting. Vertigu - phenomenon, which is an initial symptom of about half of all cases, with violation of the vertebral circulation. But more often it is accompanied by other manifestations associated with the disorder of venous blood flow, therefore, the blood supply and lack of fabric nutrition:

• vision impairment;
• diplopia;
• fucetitude;
• one-sided and double-sided oponimic hemianopsy;
• dysarthria;
• dysphagia;
• paresthesia - light paralysis, insensitivity in the face;
• various combinations of weakness or insufficient sensitivity in the legs.

Vertebro-basilar insufficiency, the symptoms of which are often alternate, can manifest only a vertigo capable of arising as an isolated sign. Long periods of recurrences (more than 6 months) with dizziness without other accompanies for LBN are notepins. The ringing in the ears and the loss of hearing do not relate to common manifestations.

Approximately 40% of cases of vertebro-basilar insufficiency attacks last 1 hour, although often the patients themselves indicate a duration of several minutes. About 90% of TIA is less than 2 hours. The difference between the 2 states is that LBN, as a rule, has a smaller duration than the TIA carotid area. The severity of symptoms is very variable, from easy to severe degree. The frequency of attack varies - from single to multiple attacks during the day.

The condition of vertebro-basilar insufficiency is a combination of symptoms. According to one group under study, 43% of patients had vertigo, 60% - ataxia, 39% -diplopia, 27% - dysarthria, 37% - Visual turbidity. Manifestations may be different depending on the lesion of the extension or intracranial part. The defeat of the extracranial vertebral part, mainly there is a dizziness, impairment of vision, violation of equilibrium, the involvement of the intracranial part is characterized only by Vertigo. Tia due to the lesion of the Basilar artery usually has 2 or more of the following symptoms:

• dizziness;
• inadless speech;
• double vision;
• dysphagia;
• one-sided or bilateral weakness in the limbs.

With vertebro-basilar failure, a sudden short-term loss of muscular tone may occur (Drop Attacks); The patient, being conscious, suddenly falls (mainly on his knees). With more severe defeat, the loss of consciousness is syncopes.

When examining patients, it is important to relate subjective symptoms with objective neurological signs of the vertebro-basilar territory. Frequent and important objective manifestations include:

• nistagm;
• eye violations;
• gorner syndrome (ptosis and meyosis, sometimes anhydrosis on the affected side);
• numbness and violation of motility on the face and limbs;
• speech disorders, coordination.

It is important to examine posture and gait. In patients as a subjective feature indicate only one symptom, for example, vertigo, with an objective study, other manifestations are determined, in particular, the ataxia of the limbs or torso. For localized lesions, variables (crossed) syndromes are typical, when on the affected side - ipsilateral - there is a refusal of the core nerve kernel, Horner syndrome or cerebellar syndrome, and hemiparesis or hemigipesthesia is formed on the contralateral side. For vertebro-basilar insufficiency, any combination of weakness, paresthesia, numbness of the upper and lower extremities, face is characterized.

Etiopathogenesis - causes and mechanisms for the development of LBN

The pathogenesis of both TIA and the LBN is essentially similar to the pathology of ischemic (lacunar, hemorrhagic) stroke. The causes of vertebro-basilar insufficiency are atherosclerosis of large vessels (31%), diseases of small vessels (16%), intraartiarium embolism (17%), cardiac embolism (27%) and various rare factors (9%).

The disease may affect not only adult women, men, but also representatives of the pediatric population. DBN in children can develop as a result of congenital pathologies of the vertebrone or basilar artery. Often, the reasons include the injuries of the child's spine during sports training, gymnastics. The relatively frequent reason is the generic injury of the spine.

The most frequent atherosclerotic vascular injuries, which are at the beginning of the vertebrid arteries, the intracranial part of the vertebrid arteries, the proximal and middle part of the basilar artery, the proximal part a. Cerebri Posterior. Smaller branches (for example, AICA, PICA) are amazed atherosclerotic process more often than large branches. The involvement of perforation fine arteriols (50-200 microns in diameter), differs from the atherosclerosis process. The process is known as lipogalin, usually associated with arterial hypertension. Due to the anatomy of these small arteriols, the consequences of their occlusion are small single or multiple trigeminal nerve infarction.

Stenotic changes in the vertebro-basilar basin can cause complications arising from hemodynamic mechanism. These are short, stereotypical and, above all, orthodox Tia. The actual deficit varies greatly depending on how much time will be required before the restoration of full blood flow.

In addition to these reasons, the disease can develop with cervical osteochondrosis, spondylise, mechanical compression a. VERTEBRALIS, especially within C1-2 in the side slope, head rotation. The slope and rotation (or in combination) represents the risk, especially for older patients, as a result of the compression of the artery a. Vertebralis can develop a TIA and ischemic stroke. In this regard, the position of the head is dangerous when washing hair at a hairdresser or incorrect maneuvers during the use of chiropractic methods.

Less common cause of vertebro-basilar insufficiency can be a plug-in syndrome (Steal Syndrom). It develops due to stenosis or occlusion start a. Subclavia (before indented a. vertebralis). With the physical activity of the upper limb on the affected side, due to ischemia, the fatigue of limbs arises, pain. At the same time there is a reverse blood flow in a. Vertebralis, therefore, arterial blood is actually excreted from the brain (steal \u003d steal, theft). The combination of pain in the upper limb with simultaneous dizziness or head pains is an indirect reason for suspected the development of a plug-in condrying syndrome. During the survey, the difference in arterial pressure between the affected and healthy upper limbs is at least 20 mm.rt. With simultaneous weakening of the pulse.

The rare cause of vertebro-basilar insufficiency is the dissection of the vertebral artery (like aneurysm), usually starting in the middle layer of the vessel wall. The dissection leads to the formation of an intramural hematoma, propagating along the vascular wall capable of creating a false channel of the stream or compression of the lumen of the vessels.

Diagnosis and examination

In the diagnosis of LBN, a visualization method is most important, similar to other TIA. This is an image of a brain tissue with CT or MRI. With vertebro-basilar insufficiency, the method is preferable, since small lesions in the brain, sometimes in cerebellum, are not identified enough. However, CT can exclude other anomalies (bleeding, tumor).

In addition to the visualization of the brain, the study of the vascular system is important in establishing a diagnosis. The main non-invasive technique is ultrasound, especially visualization of the extracranial part. In the intracranial part a. VERTEBRALIS cannot be explored in the traditional way (conventional duplex sonography), it is necessary to use transcranial ultrasonography with color encoding or transcranial dopplerography.

In more than 50% of cases, atherosclerosis of the vertebral arteries affect their intervals, which often fail to explore sonographically. Studies can even more complicate arterial hypoplasia. In suspected of the transfectal changes and other anomalies, angiography is recommended. Classical digital angiography today retreats a little on the background, because There is a possibility of performing high-quality CT or MR-angiography.

In addition to visualization methods, a standard screening is required, determining the risk factors for atherosclerosis. It is advisable to conduct a cardiac research, because 25% of patients with TIA have symptomatic and 20% asymptomatic ischemic heart disease. Mortality of patients with TIA with myocardial infarction is 5% (total mortality is 6%).

Treatment

With vertebro-basilar insufficiency, treatment depends on the exact diagnosis, etiology, the risk factors atherosclerosis. Almost always recommended drug treatment (antithrombocutic therapy), sometimes - control of hypertension, diabetes, etc.

The detection of the plug-in plot syndrome shows that we are talking about a patient with a heavy and often generalized atherosclerotic vascular disease, which should be treated with conservative (antitrombocutrum substances, influence on risk factors, prevention of complications and potential disability). In the case of expressive symptoms in the vertebro-basilar basin, angioplasty is considered by the corresponding artery.

In general, TBN forecast is more favorable than Tia in the carotid pool. First of all, this is due to the smaller risk of the subsequent stroke.

Separate attention should be paid to the treatment of dizziness. General rules for the use of drugs from vertigo:

• with acute states, vomiting and expressive vegetative escorts are treated;
• in chronic problems, funds from vertigo (if the patient's problem occurs daily); Antivertelectric drugs are not suitable for the treatment of equilibrium disorders;
• preparations are not accepted with short-term dizziness, continuing less than 30 minutes;
• reception of antiverthyginic drugs is a symptomatic treatment, part of an integrated approach, including rehabilitation.

In acute dizziness, a Tiethylperazine preparation (Takekan) is prescribed, affordable in oral, rectal and injecting form. It refers to phenothiazine neuroleptics. Rarely, in the case of a high dose, an acute extrapyramidal dystonia may develop.

With less severe vertigo, medications from the antihistamine group are used. Diazepams as an anti-nutritional means often remains in the background, although this is a very effective preparation; In case of acute dizziness, 2-10 mg of the drug is adopted. However, the elderly patients have an increased risk of unwanted symptoms.

In the case of chronic dizziness, the optimal treatment is appointed in accordance with the cause. Therapy is a symptomatic supporting. With vascular vertigo, vasoactive drugs are effective, especially pentoxifillain. From a group of antihistamine funds, betahastin has a special status, leading to vasodilation in the inner ear, which does not cause a sedative effect.

With dizziness of various etiology, cynamizine copes, but it causes a weakening when taking high doses.

Most vasoactive drugs can reduce blood pressure, cause symptoms of postural hypotension and, therefore, worsen dizziness.

Alternative methods also apply in the treatment of vertebro-basilar insufficiency:

• homeopathy - vertihegel, 10 drops (1 tablet) 3 times a day;
• LFK - Regular healing charge helps to strengthen the spine, eliminate muscle spasms; Exercises should recommend a specialist, first it is advisable to hold gymnastics in the hospital, then at home;
• folk methods - the use of herbs and additives: Vitamin C, garlic, horse chestnut - contribute to the discharge of blood.

For the prevention of disease and support for treatment, it is important to comply with a healthy lifestyle, regular movement, proper nutrition.

Finally

Transient circulatory disorders in the Vertebro Basilar Basin are common not only in old age, the problem is able to affect all age categories. Due to the volume of the vertebro-basilar territory, violations are accompanied by a wide range of symptoms of neurological nature. Modern neurosurgical methods make it possible to accurately assess the nature of the vascular disorder. Although causal treatment is effective only in exceptional cases, symptomatic therapy facilitates the symptoms of the disease. The accent in treatment is made to minimize nuclear damage, safe and rational pharmacotherapy, corresponding rehabilitation and compensation methods.