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Vertebrobasilar circulatory disorders

  • Definition
    • Vertebrobasilar circulatory disorders are conditions in which blood supply to the back of the brain is disrupted.

  • Alternative Names
    • Vertebrobasilar insufficiency; Posterior circulation ischemia

  • Causes
    • Two vertebral arteries join to form the basilar artery. These are the main blood vessels that provide blood flow to the back of the brain.

      The areas in the back of the brain that receive blood from these arteries are needed to keep a person alive. These areas control breathing, heart rate, swallowing, vision, movement, and posture or balance. All of the nervous system signals from other parts of the brain that go to the rest of the body, and the signals that go from the body back to the brain pass through the back of the brain.

      Many different conditions may reduce or stop blood flow in the back part of the brain. The most common are smoking, high blood pressure, diabetes, and a high cholesterol level. These are similar to the risk factors for any stroke.

      Vertebrobasilar vascular disorders may also be caused by a tear in the wall of an artery. Sometimes, blood clots in the heart travel to the vertebrobasilar arteries and cause a stroke.

      Less common causes of vertebrobasilar vascular disorders include connective tissue diseases, blood vessel inflammation (vasculitis), and problems in the spinal bones of the neck.

  • Symptoms
    • Common symptoms may include:

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

      Other symptoms that may occur include:

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

  • Treatment
    • Vertebrobasilar symptoms that start suddenly are a medical emergency that need to be treated right away. Treatment is similar to that for stroke.

      To treat and prevent the condition, your health care provider may recommend:

      • Taking blood-thinning drugs, such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix) to lower the risk of stroke
      • Changing your diet and medication to lower cholesterol and better control blood pressure
      • Exercising
      • Losing weight
      • Stopping smoking
  • Outlook (Prognosis)
    • The outlook depends on:

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

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

  • Possible Complications
    • Complications of vertebrobasilar circulatory disorders are stroke and its complications. These include:

      • Breathing (respiratory) failure (which may require the use of a machine to help the patient breathe)
      • Lung problems (especially lung infections)
      • Heart attack
      • Lack of fluids in the body (dehydration) and swallowing problems (sometimes requiring tube feeding)
      • Problems with movement or sensation, including paralysis and numbness
      • Formation of clots in the legs
      • Vision loss

      Complications caused by medicines or surgery may also occur.

  • When to Contact a Medical Professional
    • Call 911 or your local emergency number, or get to the emergency room if you have any symptoms of a vertebrobasilar circulatory disorder.

  • References
    • Biller J, Love BB, Schneck MJ. Vascular diseases of the nervous system. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 51A.

      Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:227-76. PMID: 20966421

      Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517-84. PMID: 21127304