Vertebrobasilar Insufficiency and Vertigo/Dizziness

Yamanaka Toshiaki

doi:10.3757/jser.83.1

Vertebrobasilar insufficiency (VBI) is a brief episode of reversible neurological deficits caused by transient ischemia of the brainstem due to impairment of the vertebrobasilar arterial system.The most common causes of VBI are atherosclerosis, which can block the posterior circulation supplying the brainstem, embolism arising from the heart and proximal vertebral and basilar arteries due to arrhythmias, as well as by hemodynamic disorder associated with changes of the blood pressure.Patients with VBI frequently present with vertigo and disequilibrium as the primary symptoms, associated with neurologic symptoms and signs, including double vision, loss of vision, gait ataxia, face and limb numbness, weakness, dysarthria and oropharyngeal dysfunction. Posterior circulation strokes are often characterized by fluctuating symptoms and signs, depending on the area of the brain that is ischemic.It is crucial to examine the pathological condition of the vessels in the vertebrobasilar system to evaluate the blood flow hemodynamics and vascular morphology in patients presenting with episodes of VBI by ultrasonography, magnetic resonance angiography, and CT angiography. VBI is usually treated with drugs that improve the cerebrovascular circulation and metabolism, antiplatelet agents, etc.VBI should be considered in the differential diagnosis in patients presenting with recurrent vertigo, and early diagnosis is important. Patients with VBI might require careful follow-up and treatment for preventing the progression of vertigo and other neurological deficits in the vertebrobasilar arterial region. Further discussions are needed to consolidate the diagnostic criteria, as well as the concept and pathogenesis of VBI associated with vertigo in the future.

Vertebrobasilar Insufficiency and Vertigo/Dizziness

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