Hypoplasia of the intracranial v4 segment of the right vertebral artery: MR signs, consequences

Each case of hypoplasia is characterized by underdevelopment of one or another organ. Such a common disease as hypoplasia of the right vertebral artery is no exception. The pathology is caused by narrowing of the vascular lumen at the site of passage in the spinal canal. Hypoplasia entails deterioration of blood circulation in the brain, visual impairment, vestibular disorders.

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Epidemiology

Hypoplasia is the most common defect of the arterial vessels of the spine. Information on the incidence is ambiguous: according to various sources, from 2.5 to 26% of the population suffers from the pathology.

Hypoplasia of the right vertebral artery is diagnosed many times more often than on the left side or on both sides. Presumably, this is related to the peculiarity of the development of vascular disorders. The right artery branches off from the subclavian vessel at an acute angle, while the left artery does so at a right angle. The diametrical lumen of the right vessel is almost always smaller than that of the left vessel, but the length is greater.

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Causes hypoplasia of the right vertebral artery.

Hypoplasia is usually congenital. Unfortunately, it is impossible to predict the onset of the disease in advance. Although specialists have discovered a certain relationship between the development of hypoplasia and some factors that occur during pregnancy.

So, the risk factors may be the following:

• Radiation exposure.
• Exposure to viruses and bacteria.
• Intoxication and poisoning during pregnancy.
• Taking medications.
• Smoking, drinking alcohol.

However, even the absolute exclusion of the listed factors cannot guarantee the absence of hypoplasia, because scientists do not yet know the exact cause of its development.

A negative role of heredity is also possible: there have been registered cases of the disease appearing in close relatives.

Despite the fact that the disease is congenital, its first signs are detected after 20 years. Their appearance can be caused by the following reasons:

• osteochondrosis of the spinal column;
• deformation of the spinal canal due to displacement of the vertebrae and spondylolisthesis;
• calcification of the vertebral-occipital membrane through which the vertebral vessel passes into the cranium;
• atherosclerotic changes in blood vessels;
• formation of blood clots inside the vertebral artery.

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Pathogenesis

Arterial blood enters the brain from a pair of large vessels - the internal carotid artery and the vertebral artery. These vessels, in turn, are also paired: they supply blood to certain areas of the right and left cerebral hemispheres. The connecting section of the branches of these arterial vessels is called the Circle of Willis. The circle is a vascular network that compensates for the blood flow if any of the vessels stops functioning. Therefore, such self-regulation prevents the development of hypoxia and damage to the brain.

The right vertebral artery is part of the circle of Willis. It emerges from the subclavian artery, passes into the spinal canal, and through it into the cranium.

Along its course, the vertebral artery bends several times, which is necessary to pass through the narrowed openings of the bones.

In hypoplasia of the right vertebral artery, a congenital type of underdevelopment and a decrease in the vessel diameter are observed. Of course, the blood supply to the brain is significantly disrupted in this case. If there are other problems in the Willis circle, then there is a risk of developing serious brain damage.

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Symptoms hypoplasia of the right vertebral artery.

Hypoplasia of the right vertebral artery in children almost never manifests itself: the first signs are detected after 20 years, sometimes much later.

The first signs may be expressed in the following symptoms and symptom complexes:

General cerebral symptoms	Head pain, vertigo
Focal signs of arterial disturbances in the cerebral hemispheres	Feeling of weakness in the limbs on one side, paresthesia, mild paresis
Focal signs of damage to the occipital lobe	Deterioration of vision, blurred vision
Stem and vegetative-vascular disorders	Blood pressure surges
Cerebellar disorders	Unsteady gait, poor coordination

Symptoms almost always develop gradually, depending on the severity of the vessel damage. Sometimes the symptoms worsen, after which a stage of relief occurs. This is the main danger: the patient feels better, and he delays treatment.

It is worth noting that the symptoms of the disease cannot be called strictly specific. They can easily be confused with other diseases, for example, with neurocirculatory dystonia or discirculatory encephalopathy. An accurate diagnosis is determined only after diagnostic measures have been carried out.

Hypoplasia of the intracranial segment of the right vertebral artery

The incranial segment is the section of the vertebral artery that passes through the cranial cavity, i.e., is in close proximity to the brain structures. If the narrowing of the artery in this area becomes critical, the consequences will be especially unfavorable.

Initial symptoms can be quite vague:

• regular dizziness without any particular reason;
• periodic headaches;
• vestibular disorders - usually sudden and transient;
• nervous system disorders;
• loss or distortion of sensation in the neck or limbs;
• regular problems with blood pressure.

Over time, the disease progresses. Dizziness can end in loss of consciousness, a sharp disturbance of spatial orientation, and a disorder of coordination. The patient often and suddenly falls, his gait becomes unsteady and uncertain.

Signs of the disease become more noticeable with age, when the deterioration of hemodynamics increases as age-related changes appear in the body.

Hypoplasia of the v4 segment of the right vertebral artery

The right vertebral artery originates from the subclavian artery, entering the cranial space at the level of C1 through the foramen magnum.

The intracranial or intradural v4 segment rises anteriorly from the medulla oblongata, reaching the midline, where it merges with the contralateral vertebral artery, forming the basilar vessel.

Most specialists do not share such segmentation as specific in terms of clinical manifestations. Expressed symptomatic differences can be observed only in case of obvious disorders of individual functions of the brain, since the blood from the subclavian artery feeds its different parts. Therefore, ischemic processes in different areas lead to different consequences and complications. At the same time, the clinical picture of hypoplasia is almost always the same.

Moderate hypoplasia of the right vertebral artery

Moderate changes in the shape of the vertebral artery due to hypoplasia may remain hidden and not manifest themselves throughout life. This is the most favorable form of the disease. Often, it is discovered by chance, during routine diagnostics, or when visiting a doctor about other diseases.

Moderate hypoplasia usually does not affect the functional and throughput capacity of the arterial vessel, so the degree of risk of developing negative consequences is considered extremely low.

Hypoplasia of the right vertebral artery in children

The disease is considered congenital, but its first manifestations begin to bother already in adulthood. Thus, the child's parents may not know about the pathology for a long time. The first signs in the patient may appear at 17-20, or even at 40-50 years.

In childhood, minor disturbances of blood flow in the affected artery are compensated by the presence of another arterial vessel on the left side. Since the body has large compensatory capabilities, the disturbance is unnoticeable and does not cause problems for the child.

With age, other pathologies associated with the vascular system may arise. This places additional stress on the affected artery: and only then do the signs of the disease begin to reveal themselves in one form or another. The patient begins to complain of dizziness (sometimes with nausea), numbness of the limbs, changes in coordination, vision problems. But all these signs appear at a later age.

Complications and consequences

Hypoplasia usually does not manifest itself in any way until a certain moment, and sometimes throughout life: everything depends on the individual characteristics of the patient.

It is impossible to predict the probability of adverse effects in case of hypoplasia of the right vertebral artery. In most patients, the pathology occurs against the background of many functional disorders of various organs and entire systems. Often, difficulties arise with diagnosis.

According to observations, the most common consequences of hypoplasia can be:

• visual and auditory impairment;
• migraines, headaches;
• state of fatigue, decreased ability to work;
• depressed state, irritability, disorders of the autonomic nervous system;
• thrombosis of affected arteries;
• strokes, cerebrovascular accidents.

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Diagnostics hypoplasia of the right vertebral artery.

Diagnostic tests will help to establish the correct diagnosis.

The analyses include standard and specific studies:

• a standard blood test is performed to determine the number of red blood cells, white blood cells, hemoglobin levels, ESR, which provides information about the presence of an inflammatory process in the body;
• Specific tests allow us to determine the level of various biological substances – enzymes, peptides, metabolites, etc.

For the diagnosis of hypoplasia, tests are of secondary importance: they are carried out to obtain general information about the state of the body.

Instrumental diagnostics consists of the following procedures:

• Ultrasound of the vascular network of the head and neck (duplex vascular scanning of the artery along its length in the cervical canal).
• Angiography (graphic recording with assessment of the condition of the vertebral artery).
• Computed tomography and magnetic resonance imaging with contrast enhancement.

In any type of diagnostics, the diametrical size of the right vertebral artery serves as a reference point. In a healthy person, it should be 3 mm. MRI signs of hypoplasia of the right vertebral artery are an artery diameter of less than 3 mm, that is, up to 2 or less millimeters.

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Differential diagnosis

Differential diagnostics should be carried out with reflex spasm of the vertebral artery, in which the lumen changes are reversible. This can be verified using a functional test - a hypercapnic test, the results of which can be:

• in case of vertebral artery hyperplasia: resistant low-velocity Doppler blood flow curve, average time-dependent maximum blood flow velocity ≤14.8 cm/s, vertebral artery diameter ≤2.3 mm with growth during hypercapnic test ≤0.1 mm;
• in case of reflex spasm: a peak-shaped split type of Doppler blood flow curve with complete or incomplete stabilization of the shape and an increase in the diameter of the vertebral artery ≤0.2 mm as a result of hypercapnia.

Treatment hypoplasia of the right vertebral artery.

There are several ways to alleviate the condition of a patient with hypoplasia of the right vertebral artery:

1. Traditional drug treatment. It involves the use of drugs that have a positive effect on the blood composition, improve blood circulation in the cerebral vessels and accelerate metabolism. The drugs will not lead to a complete cure, but will help prevent a critical deterioration in the condition. As a rule, the drugs prescribed are acetylsalicylic acid, Tiocitam, Ceraxon, Trental, Cinnarizine, Actovegin, Cerebrolysin, Vinpocetine, etc.
2. Surgical intervention. It is resorted to only in extreme cases, after unsuccessful attempts to improve cerebral circulation using conservative therapy. The operation is quite complex - it is an endovascular intervention and is performed by neurosurgeons.

Treatment of the disease does not always lead to positive dynamics. However, in the absence of therapy, the prognosis looks much worse.

Medicines

Name of the drug	Method of administration and dosage	Side effects	Special instructions
Cinnarizine	Prescribed: 1 tablet three times a day.	Possible reactions include drowsiness, dyspepsia, and allergies.	Cinnarizine is best taken after meals to minimize irritation of the digestive tract.
Actovegin	Prescribed orally 1-2 tablets three times a day before meals.	Sweating, increased body temperature, and allergies may occur.	In severe cases, parenteral administration of the drug is used.
Cerebrolysin	Administered intramuscularly or intravenously, after dilution in sodium chloride solution or 5% glucose solution. Dosages are individual.	Rarely, with rapid administration, dizziness, headache, and tachycardia are observed.	The drug is not used to treat patients with allergic diathesis and renal failure.
Trental	Prescribed 2-4 tablets up to three times a day, or intravenously in the form of a solution - according to indications.	Possible facial flushing, headache, irritability.	Trental is used with caution in cases of gastric ulcer, heart failure, and in the postoperative period.
Vinpocetine	Prescribed 1-2 tablets three times a day, for a long time.	Possible symptoms include dizziness, nausea, redness of the upper body, and tachycardia.	In severe cases, Vinpocetine is administered intravenously by drip.

Vitamins

To prevent complications, treatment should be supplemented with vitamins, which are part of food products or in the form of pharmaceutical preparations. The following vitamins are considered the most suitable for hypoplasia:

• Retinol (A) – improves metabolism, prevents vascular damage from atherosclerosis. Contained in fish oil, dairy products, carrots, pumpkin, bell peppers.
• Ascorbic acid (C) – prevents the formation of cholesterol plaques, strengthens the heart and vascular walls. Contained in berries, fruits, citrus fruits.
• Rutin (P) – makes the vascular wall strong. Contained in citrus fruits, berries, rose hips.
• Tocopherol (E) is an antioxidant, improves fat metabolism and prevents intoxication. It is found in vegetable oils, eggs, and nuts.
• Pyridoxine (B ₆ ) – removes excess cholesterol, stabilizes metabolic processes. Contained in fish, dairy products, brown rice, beans.

If the doctor recommends multivitamin preparations, then you should pay attention to the following products:

• Vitrum cardio;
• Doppel Hertz Cardio System-3;
• Vitalarix Cardio;
• Cardio forte;
• Centrum cardio.

Physiotherapy treatment

In case of hypoplasia of the right vertebral artery, physiotherapy is not the first-line therapeutic method. However, its use helps to alleviate the patient's condition and eliminate individual unpleasant symptoms of the disease.

The following physiotherapeutic interventions are permitted:

• Physical therapy – includes a set of exercises to restore blood circulation, walking.
• Mud therapy – normalizes the functioning of the nervous and cardiovascular systems.
• Hydrotherapy, mineral waters, contrast shower.
• Fresh baths with warm water relax and calm the nervous system.
• Dry carbon dioxide bath – helps to dilate blood vessels and lower blood pressure.

Electrosleep, pine baths and other procedures improve well-being. The standard course of physiotherapy lasts 10 days.

Folk remedies

Treatment with folk remedies, unfortunately, will not be able to completely cure the disease. But with the help of such recipes, you can improve the patient's condition and prevent the development of exacerbations and complications. It is better if folk remedies are used against the background of traditional treatment prescribed by a doctor.

• Pour six full tablespoons of dried hawthorn berries and motherwort herb into a thermos. Pour 1500 ml of boiling water and leave overnight. In the morning, filter the infusion and drink 100 ml up to 4 times a day.
• Squeeze the juice from ten lemons. Peel five heads of garlic, pass the cloves through a press. Mix all the ingredients with a liter of honey, place in a jar, cover with a lid and put in the refrigerator for one week. After seven days, the medicine can be consumed: 4 teaspoons half an hour before dinner, gradually dissolving the mass in the mouth.
• We definitely include dried apricots in our diet: it is recommended to eat 100-150 g every day. This will improve the condition of the heart and blood vessels.
• We prepare a decoction from bean pods in a ratio of 1:10. We use it 100 ml three times a day 30 minutes before meals. The decoction improves heart function, eliminates edema, prevents atherosclerosis, and normalizes blood pressure.
• We use natural honey 1 tbsp. three times a day. Honey can be diluted in warm water or poured over fruits.

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Herbal treatment

• Such a well-known plant as dandelion perfectly stabilizes the level of cholesterol in the blood. For example, powder from dandelion rhizome is taken one third of a teaspoon three times a day about half an hour before meals.

Fresh leaves are added to salads and soups: in addition to the atherosclerotic effect, the leaves have anti-anemic and joint-protective activity.

• To prevent complications with hypoplasia, it is recommended to prepare tea from St. John's wort (20 g), fireweed (50 g), motherwort (15 g), and birch leaves (15 g). One tablespoon of the mixture is infused in 300 ml of boiling water for twenty minutes. It is consumed instead of tea throughout the day.
• Tincture of elecampane helps: 30 g of rhizome is poured with 300 ml of vodka and kept in the dark for 40 days. For treatment, 35 drops of tincture are taken in 100 ml of water 20 minutes before meals.

To reduce the frequency of attacks, it is recommended to include in herbal infusions such plants as lemon balm, mint, immortelle, mistletoe, adonis, and bedstraw.

Homeopathy

Along with medications, homeopathic remedies prescribed by a doctor of the appropriate specialty are also popular. Homeopathy affects the body according to the principle of "treating like with like." There are a number of drugs that have a positive effect on the vertebral arteries and blood vessels of the brain.

• Cholesterinum – lowers cholesterol levels, improves the condition of blood vessels in atherosclerosis.
• Golden iodine is effective in treating atherosclerosis of cerebral vessels.
• Conium - helps with stroke and post-stroke conditions.
• Crategus – improves cerebral circulation.

In case of circulatory failure, complex homeopathic preparations can be used:

• Traumeel in the form of tablets and ointment;
• Tsel T - in the form of tablets and ointment;
• Discus compositum in the form of intramuscular injections.

The dosage of the drugs is selected individually. Side effects are practically absent: only rarely does an allergic reaction to one or another drug occur - in isolated cases.

Surgical treatment

The essence of the operation for hypoplasia of the right vertebral artery is the restoration of normal blood flow in it, which simultaneously serves as the prevention of severe and life-threatening consequences.

Previously, to improve the patient's condition, an extra-intracranial anastomosis was surgically applied. But such an operation was subsequently recognized as ineffective and lost its relevance.

In order to qualitatively restore blood flow, the following surgical methods are used today:

1. Stenting is the insertion of a special “insert” into a narrowed section of a vessel to prevent its further narrowing. Stents can be a mini-structure similar to a frame, which is often additionally impregnated with medicinal solutions to prevent thrombus formation and the formation of cicatricial changes in the vessel.
2. Angioplasty is the restoration of the artery's original shape. During the operation, mechanical action is applied to the narrowed area (usually balloon dilation of the vessel), which allows the lumen's original diameter to be restored.
3. A reconstructive operation is the removal of a narrowed section of a vessel with subsequent prosthetic replacement. A part of the patient's own vein, taken from other areas, is usually used as a prosthesis. Such an operation is performed only in the most severe cases.

Often, stenting and angioplasty are performed in combination with each other.

After the operation, patients are prescribed blood thinning therapy and special exercises to normalize general blood circulation. Moderate physical activity after the operation helps prevent the formation of blood clots. However, the loads should be moderate: intensive exercise and lifting weights are contraindicated during this period.

Prevention

There is no specific prevention of hypoplasia, because scientists have not yet found out the exact cause of the disease. The following can be stated unequivocally: during pregnancy, a woman should maintain the healthiest possible lifestyle, avoid taking any medications, and monitor her own health.

If a person already has vertebral artery hypoplasia, it is important to do everything possible to prevent acute cerebrovascular accident. To do this, it is necessary to regularly carry out the following activities:

• monitor blood pressure levels;
• control blood cholesterol levels;
• maintain normal body weight, be physically active, give up bad habits;
• Check your blood glucose levels periodically.

It is recommended to carry out monotherapy with antiplatelet agents in courses, for example, acetylsalicylic acid in the amount of 325 mg per day, or clopidogrel.

Hypoplasia of the right vertebral artery and sports

In almost all cases of right vertebral artery hypoplasia, sports are relevant, and for some patients, they are simply necessary. However, some people who have learned about their disease often give up sports because they are afraid of harming themselves.

Of course, if sports activities are associated with excessive loads on the spine and vascular system, then it is better to leave them. However, you should not completely abandon physical exercises. You can always choose a set of exercises or a type of sport that will be useful for arterial disease. For example, if weightlifting and high jumps can become dangerous, then swimming and long walks, on the contrary, will give the body additional energy and strengthen blood vessels.

When choosing physical exercises, you should avoid those that cause pain and discomfort. The choice should be made in favor of smooth, slow and not abrupt movements. Over time - for example, in 2-4 months, the intensity of the exercises can be increased.

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Gymnastics for hypoplasia of the right vertebral artery

With regular practice of special gymnastics, you can achieve tangible results: normal blood circulation is restored, your well-being improves significantly, and you feel more energetic.

Of course, we should not forget that gymnastics will not be able to completely eliminate hypoplasia. However, with regular exercise, you can "forget" about the disease for a long time.

The gymnastic complex includes the following exercises:

1. Sit on a chair, keeping your back straight. Relax your arms, lower them down. Turn your head ten times to one side and then to the other, with maximum amplitude. If pain occurs, make the movement smoother.
2. We remain in the same position. We lower our head down and try to touch our chin to our chest. We stop for ten seconds. We do five repetitions like this.
3. Sit on a chair, arms relaxed. Pull in your chin and try to move your head back. Repeat ten times.
4. Sitting on a chair, place the palm of any hand on your forehead. Tilt your head forward, resting your forehead on your palm. Hold for ten seconds. Do ten repetitions.
5. Stand up straight, relax your arms. Raise your shoulders as high as possible, hold for ten seconds, then relax your shoulders, inhale deeply. Repeat up to ten times.
6. Lie down on the floor, on your back, lift your head, hold for ten seconds, return to the previous position. Repeat 8-10 times.

The listed exercises will help to cope with unpleasant sensations in the neck and head area, as well as prevent the development of undesirable consequences of hypoplasia.

Forecast

Hypoplasia of the right vertebral artery is an important probable factor in the development of acute cerebrovascular accident, which requires a special approach to diagnosis and therapy.

The general prognosis cannot be unambiguous: it depends on the severity of the narrowing of the vessel, the degree of activation of compensation mechanisms, and the presence of other diseases in the body.

If the patient does not notice a significant deterioration in his condition and does not present serious complaints, then the prognosis is considered relatively favorable.

If the patient has pronounced signs of vertebrobasilar insufficiency, the prognosis in this case worsens. Surgical intervention may be required, which in most cases gives good results.

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Disability

The decision to assign disability to a patient with hypoplasia of the right vertebral artery is made by a specialized commission of the Medical and Social Expertise Commission. Disability is assigned not so much taking into account the disease, but taking into account signs of dysfunction and decompensation of the mechanisms that ensure normal human life. That is, if hypoplasia was detected during diagnosis, but the patient feels well, and his complaints about health are not critical, then he may be denied disability.

If hypoplasia of the right vertebral artery has led to severe complications, loss of ability to work, etc., then specialists have the right to consider the possibility of disability.

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