Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2018; 15 (2): 65-144 ➤ Современный зарубежный опыт изучения вертебробазилярной недостаточности: клинические проявления и проблемы диагностики

Modern foreign experience of study of vertebral-basilar insufficiency: clinical manifestations and diagnostic challenges

Authors: M.V. Shumilina 1, E.V. Emets 2

Company:
1Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
2Voronezh Regional Clinical Hospital No 1, Moskovskiy prospekt, 151, Voronezh, 394066, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2018-15-2-75-82

UDC: 616.133.33-005-07

Link: Clinical Physiology of Blood Circulaiton. 2018; 15 (2): 75-82

Quote as: Shumilina M.V., Emets E.V. Modern foreign experience of study of vertebral-basilar insufficiency: clinical manifestations and diagnostic challenges. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2018; 15 (2): 75–82 (in Russ.). DOI: 10.24022/1814-6910-2018-15-2-75-82

Keywords:  dizziness vertebral artery extravascular compression transverse processes venous outflow disorders ultra-sound diagnostic

Received / Accepted:  05.02.2018/08.02.2018

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Abstract

In the present review, the opinion of foreign colleagues to the problem of vertebral-basilar insufficiency, the causes of its development and peculiarities of clinical manifestations and diagnostic priorities. It is believed that the most common cause of vertebral-basilar insufficiency is atherosclerosis of the vertebral arteries, and then embolism and dissection of the artery walls. More rare reasons are called migraine, fibrosal dysplasia, coagulopathy and drug abuse. Extravascular compression of vertebral arteries of pathologically changed cervical vertebrae is considered a rare observation. Cases of congenital extravascular compression of vertebral artery in adults, unlike children abroad are registered very rarely. In the available foreign literature there are no data on the role of violations of cerebral venous outflow of arteriovenous imbalance and flavovirens in the development of the vertebral-basilar insufficiency. The main diagnostic criterion is the reduction of blood flow velocity in the vertebral artery.
According to our center in the first place in frequency of pathology of the vertebral artery are ekstravasal compression in 1 segment and septal stenosis in the reserve loops on the second – hypoplasia, tortuosity and stenosis in the proximal, 3 – occlusion and the defeat in the 2nd segment. A significant role is played by disorders of the venous outflow. With increasing venous pressure is disturbed arteriovenous balance with the fall in perfusion pressure and ischemia in the more compromised the pool of the brain. That is why a decisive role in the diagnosis plays a complex ultrasound examination not only of the arteries with functional tests, but also of veins with a measurement of systemic arterial and venous pressures.

References

  1. Kubik C.S., Adams R.D. Occlusion of the basilar artery; a clinical and pathological study. Brain. 1946; 69 (2): 73–121.
  2. Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke. 1990; 21 (4): 637–76.
  3. Koch H.K., Smith M.C. Office-based ambulatory care for patients 75 years old and over: National Ambulatory Medical Care Survey, 1980 and 1981. US Department of Health and Human Services, Public Health Service, National Center for Health Statistics; 1985.
  4. Kroenke K., Mangelsdorff A.D. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am. J. Med. 1989; 86: 262–6.
  5. Koziol-McLain J., Lowenstein S.R., Fuller B. Orthostatic vital signs in emergency department patients. Ann. Emerg. Med. 1991; 20: 606–10.
  6. Furman J.M., Cass S.P. Balance disorders: a case-study approach. FA Davis Philadelphia, PA; 1996.
  7. Baloh R.W. Vertigo. Lancet. 1998; 352: 1841–6.
  8. Alshahrani A., Johnson E.G., Cordett T.K. Vertebral artery testing and differential diagnosis in dizzy patients. Phys. Ther. Rehabil. 2014; 1: 3. DOI: 10.7243/ 2055-2386-1-3
  9. Lima Neto A.C., Bittar R., Gattas G.Sc., Bor-Seng-Shu E., de Lima Oliveira M., da Costa Monsanto R., Bittar L.F. Pathophysiology and diagnosis of vertebrobasilar insufficiency: a review of the literature. Intern. Arch. Otorhinolaryngol. 2017; 21: 302–7.
  10. Savitz S.I., Caplan L.R. Vertebrobasilar disease. N. Engl. J. Med. 2005; 352 (25): 2618–26.
  11. 1Caplan L.R., Gorelick P.B., Hier D.B. Race, sex and occlusive cerebrovascular disease: a review. Stroke. 1986; 17 (4): 648–55.
  12. Caplan L.R. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology. 1989; 39 (9): 1246–50.
  13. Fleming J.B., Vora T.K., Harrigan M.R. Rare case of bilateral vertebral artery stenosis caused by C4–5 spondylotic changes manifesting with bilateral Bow Hunter's syndrome. World Neurosurg. 2013; 79: 799.
  14. Duan G., Xu J., Shi J., Cao Y. Advances in the pathogenesis, diagnosis and treatment of Bow Hunter's syndrome: a comprehensive review of the literature. Intervent. Neurol. 2016; 5: 29–38.
  15. Jost G.F., Dailey A.T. Bow Hunter's syndrome revisited: 2 new cases and literature review of 124 cases. Neurosurg. Focus. 2015; 38: E7.
  16. Gordhan A., Lockhart C. Congenital bilateral C2 transverse foramina stenosis causing adult-onset vertebrobasilar insufficiency and posterior circulation stroke. Case. Rep. Neurol. 2017; 9: 137–42.
  17. Namini A., Naylor M., Koenigsberg R.A. Vertebrobasilar insufficiency and stroke – a review of posterior circulation diagnostic imaging and endovascular treatment options. J. Am. Osteopath. Coll. Radiol. 2015; 4: 15–23.
  18. Stręk P., Reroń E., Maga P., Modrzejewski M., Szybist N. A possible correlation between vertebral artery insufficiency and degenerative changes in the cervical spine. Eur. Arch. Otorhinolaryngol. 1998; 255 (9): 437–40.
  19. Machaly S.A., Senna M.K., Sadek A.G. Vertigo is associated with advanced degenerative changes in patients with cervical spondylosis. Clin. Rheumatol. 2011; 30 (12): 1527–34.
  20. Grover Sh., Khanna G.L. Association between vertebral artery blood flow and cervical vertigo. Intern. Res. J. Nat. Appl. Sci. 2017; 4 (2): 18–32.
  21. Grad A., Baloh R.W. Vertigo of vascular origin: clinical and electronystagmographic features in 84 cases. Arch. Neurol. 1989; 46: 281–4.
  22. 2Simoceli L., Bittar R.M.S., Bottino M.A., Bento R.F. Perfil diagnóstico do idoso portador de desequilíbrio corporal: resultados preliminaries. Rev. Bras. Otorrinolaringol. 2003; 69: 772–7.
  23. 2Moubayed S.P., Saliba I. Vertebrobasilar insufficiency presenting as isolated positional vertigo or dizziness: a double-blind retrospective cohort study. Laryngoscope. 2009; 119 (10): 2071–6.
  24. Bradshaw P., McQuaid P. The syndrome of vertebrobasilar insufficiency. Q. J. Med. 1963; 32: 279–96.
  25. Bruyn G.W. Vertigo and vertebrobasilar insufficiency. A critical comment. Acta Otolaryngol. Suppl. 1988; 460: 128–34.
  26. Caplan L. Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. Stroke. 2000; 31 (8): 2011–23.
  27. Rivera V.M., Meyer J.S., Baer P.E., Faibish G.M., Mathew N.T., Hartmann A. Vertebrobasilar arterial insufficiency with dementia. Controlled trials of treatment with betahistine hydrochloride. J. Am. Geriatr. Soc. 1974; 22: 397–406.
  28. Morris J.C. Dementia update 2003. Alzheimer Dis. Assoc. Disord. 2003; 17: 245–58.
  29. Korczyn A.D., Vakhapova V., Grinberg L.T. Vascular dementia. J. Neurol. Sci. 2012; 322: 2–10.
  30. Yang F.-C., Chen S.-Y., Yin J.-H., Lin C.-C., Sung Y.-F., Chou C.-H. et al. The association between vertebrobasilar insufficiency and the risk of dementia: a nationwide registerbased retrospective cohort study in Taiwan. B.M.J. Open. 2017; 7: 1–8. DOI: 10.1136/ bmjopen-2017-017001
  31. Gomez C.R., Cruz-Flores S., Malkoff M.D., Sauer C.M., Burch C.M. Isolated vertigo as a manifestation of vertebrobasilar ischemia. Neurology. 1996; 47 (1): 94–7.
  32. Barker S., Kesson M., Ashmore J., Turner G., Conway J., Stevens D. Professional issue. Guidance for pre-manipulative testing of the cervical spine. Man Ther. 2000; 5: 37–40.
  33. Mitchell J.A. Changes in vertebral artery blood flow following normal rotation of the cervical spine. J. Manipulative Physiol. Ther. 2003; 26: 347–51.
  34. Vidal P.G. Vertebral artery testing as a clinical screen for vertebro-basilar insufficiency: is there any diagnostic value? Orthop. Phys. Ther. Pract. 2004; 16: 7–12.
  35. Richter R.R., Reinking M.F. Evidence in practice. How does evidence on the diagnostic accuracy of the vertebral artery test influence teaching of the test in a professional physical therapist education program? Phys. Ther. 2005; 85: 589–99.
  36. Clendaniel R.A., Landel R. Cervical vertigo. In: Herdman S.J. (Ed.) Vestibular rehabilitation. 3rd ed. Philadelphia, PA: F.A. Davis; 2007: 467–84.
  37. Schubert M.C. Vestibular disorders. In: O'Sullivan S.B., Schmitz T.J. (Eds.) Physical rehabilitation: assessment and treatment. 5th ed. Philadelphia, PA: F.A. Davis; 2007: 999–1029.
  38. Tusa R.J. History and clinical examination. In: Herdman S.J. (Ed.) Vestibular rehabilitation. 3rd ed. Philadel-phia, PA: F.A. Davis; 2007: 108–24.
  39. Magee D.J. Orthopedic physical assessment. St. Louis: Elsevier Health Sciences; 2008.
  40. Sloan M.A., Alexandrov A.V., Tegeler C.H., Spencer M.P., Caplan L.R., Feldmann E. et al. Therapeutics and technology assessment subcommittee of the American Academy of Neurology. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2004; 62 (9): 1468–81.
  41. Nakagawa T., Yamane H., Nakai Y., Shigeta T., Takashima T. Evaluation of the vertebrobasilar artery system by magnetic resonance angiography in the diagnosis of vertebrobasilar insufficiency. Acta Otolaryngol. Suppl. 1998; 538: 54–7.
  42. Kidwell C.S., Alger J.R., Di Salle F., Starkman S., Villablanca P., Bentson J., Saver J. Diffusion MRI in patients with transient ischemic attacks. Stroke. 1999; 30 (6): 1174–80.
  43. Marx J.J., Mika-Gruettner A., Thoemke F., Fitzek S., Fitzek C., Vucurevic G. et al. Diffusion weighted magnetic resonance imaging in the diagnosis of reversible ischaemic deficits of the brainstem. J. Neurol. Neurosurg. Psychiatry. 2002; 72 (5): 572–5.
  44. Nakagawa T., Shigeta T., Takashima T., Tomiyama K. Magnetic resonance angiography evaluation of basilar artery stenosis in patients with vertebrobasilar insufficiency. Eur. Arch. Otorhinolaryngol. 2000; 257 (8): 409–11.
  45. Kim S.H., Lee J.S., Kwon O.K., Han M.K., Kim J.H. Prevalence study of proximal vertebral artery stenosis using high-resolution contrastenhanced magnetic resonance angiography. Acta Radiol. 2005; 46 (3): 314–21.
  46. Khan S., Cloud G.C., Kerry S., Markus H.S. Imaging of vertebral artery stenosis: a systematic review. J. Neurol. Neurosurg. Psychiatry. 2007; 78 (11): 1218–25.
  47. Hua Y., Meng X.-F., Jia L.-Y., Ling Ch., Miao Zh.-R., Ling F., Liu J.-B. Color Doppler imaging evaluation of proximal vertebral artery stenosis. Am. J. Roentgenol. 2009; 193 (5): 1434–8.
  48. Alnaami I., Siddiqui M., Saqqur M. The diagnosis of vertebrobasilar insufficiency using transcranial Doppler ultrasound. Case Rep. Med. 2012; Article ID 894913. DOI: 10.1155/2012/894913
  49. Arnolds B.J., von Reutern G.M. Transcranial Doppler sonography. Examination technique and normal reference values. Ultrasound Med. Biol. 1986; 12 (2): 115–23.
  50. Tegeler C.H., Crutchfield K., Katsnelson M., Kim J., Tang R., Griffin L.P. et al. Transcranial Doppler velocities in a large, healthy population. J. Neuroimag. 2013; 23 (3): 466–72.
  51. Шумилина М.В. Нарушения венозного церебрального кровообращения у больных с сердечно-сосудистой патологией: Дис. ... д-ра мед. наук. М.; 2002. [Shumilinа M.V. Disorders of cerebral venous circulation in patients with cardiovascular disease: Dr. Med. Sc. Diss. Moscow; 2002 (in Russ.).]
  52. Бокерия Л.А., Бузиашвили Ю.И., Шумилина М.В. Нарушения венозного церебрального кровообращения у больных с сердечно-сосудистой патологией. Головная боль, ишемия мозга, артериосклероз. М.: НЦССХ им. А.Н. Бакулева; 2003. [Bockeria L.A., Buziashvili Yu.I., Shumilina M.V. Violations of cerebral venous circulation in patients with cardiovascular disease. Headache, cerebral ischemia, arteriosclerosis. Moscow; 2003 (in Russ.).]
  53. Шумилина М.В., Махмудов Х.Х., Мукаева А.В. Что такое «гемодинамически значимое» поражение? Клиническая физиология кровообращения. 2011; 3: 39–44. [Shumilina M.V., Makhmudov Kh.Kh., Mukaeva A.V. What is a hemodynamically significant lesion? Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2011; 3: 39–44 (in Russ.).]
  54. Шумилина М.В., Махмудов Х.Х., Мукасеева А.В., Стрелкова Т.В. Способ измерения венозного давления. Патент РФ, No 2480149; 2013. [Shumilina M.V., Makhmudov Kh.Kh., Mukaseeva A.V., Strelkova T.V. Method of measuring venous pressure; d. Patent RF, No 2480149; 2013 (in Russ.).]
  55. Шумилина М.В. Ангиологические основы комплексной ультразвуковой диагностики патологии сосудов. Клиническая физиология кровообращения. 2016; 13 (1): 5–36. [Shumilina M.V. Angiological bases of complex ultrasonic diagnostics of a pathology of vessels. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2016; 13 (1): 5–36 (in Russ.).]

About Authors

Shumilina Margarita Vladimirovna, Dr. Med. Sc., Head of the Group of Ultrasound Studies of Cardiovascular and Organ Pathology, Doctor of Ultrasonic Diagnostics; orcid.org/0000-0001-9871-8173
Emets Ekaterina Viktorovna, Doctor of Functional Diagnostics

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