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

Each of the cases of hypoplasia is characterized by underdevelopment of one or another organ. Not an exception and such a common disease as hypoplasia of the right vertebral artery. Pathology is due to the narrowing of the vascular lumen on the passage in the vertebral canal. Hypoplasia leads to deterioration of blood circulation in the brain, visual impairment, vestibular disorders.

[1], [2], [3], [4]

Epidemiology

Hypoplasia is the most common defect in the arteries of the spine. Information about the incidence is ambiguous: according to different sources, pathology affects 2.5 to 26% of the population.

Hypoplasia of the right vertebral artery is diagnosed at times more often than on the left side or on both sides. Presumably, this has to do with the peculiarities of the development of vascular disorders. The right artery branches off from the subclavian vessel at an acute angle, whereas the left artery is at right angles. The diametral lumen of the right vessel is almost always smaller than that of the left vessel, but the length is longer.

[5], [6], [7]

Causes of the hypoplasia of the right vertebral artery

Hypoplasia, as a rule, is congenital in nature. And in advance to predict the appearance of the disease, unfortunately, it is impossible. Although experts have found a certain relationship between the development of hypoplasia and some factors that occur during pregnancy.

So, risk factors can be the following:

• Radiation irradiation.
• The effects of viruses and bacteria.
• Intoxication and poisoning during pregnancy.
• Reception of medicines.
• Smoking, drinking alcohol.

Nevertheless, even the absolute exclusion of these factors can not guarantee the absence of hypoplasia, because the exact cause of its development, scientists do not yet know.

The negative role of heredity is also permissible: cases of the appearance of the disease among the next of kin were recorded.

Despite the fact that the disease is congenital, its first signs are found after 20 years. Their appearance can cause such reasons:

• osteochondrosis of the spine;
• deformation of the spinal canal due to displacement of the vertebrae and spondylolisthesis;
• calcification of the vertebral-occipital membrane, by means of which the vertebral vessel passes into the skull;
• atherosclerotic changes in the vessels;
• formation of thrombi within the vertebral artery.

[8], [9], [10], [11]

Pathogenesis

To the brain, arterial blood comes 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 portion of the branches of these arterial vessels is called the Willis circle. A circle is a vasculature that compensates for blood flow if any of the vessels ceases to function. So, this self-regulation prevents the development of hypoxia and damage in the brain.

The right vertebral artery is part of the Willis circle. It leaves the subclavian artery, passes into the canal of the spine, and through it into the skull.

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

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

[12], [13], [14], [15], [16], [17]

Symptoms of the hypoplasia of the right vertebral artery

Hypoplasia of the right vertebral artery in children is almost never manifested: the first signs are found after 20 years, sometimes - much later.

The first signs can be expressed in the following symptoms and symptoms:

General cerebral symptoms	Pain in the head, vertigo
Focal signs of arterial disorders in the cerebral hemispheres	Feeling of weakness in the limbs on the one hand, paresthesia, paresis in mild form
Focal signs of damage to the occipital lobe	Deterioration of vision, blurred vision
Stem and vegetovascular disorders	Blood pressure jumps
Disorders from the cerebellum	Uncertain gait, coordination disorders

Symptoms almost always occur gradually, depending on the severity of the vascular lesion. Sometimes the symptoms become worse, after which the stage of relief begins. This is the main danger: the patient becomes easier, and he delays with treatment.

It is worth noting that the signs of the disease can not be called strictly specific. They can easily be confused with other diseases, for example, with neurocirculatory dystonia or dyscirculatory encephalopathy. The exact diagnosis is determined only after the diagnostic activities.

Hypoplasia of the intracranial segment of the right vertebral artery

An abnormal segment is that part of the vertebral artery that passes through the cranial cavity - that is, is in close proximity to the brain structures. If the narrowing of the artery in this place becomes critical, the consequences will be particularly unfavorable.

Primary symptoms can be quite blurred:

• regular dizziness for no particular reason;
• periodic headaches;
• Vestibular disorders - as a rule, sudden and transient;
• disorders of the nervous system;
• loss or distortion of sensitivity in the neck or extremities;
• regular problems with blood pressure.

Over time, the disease progresses. Vertigo may result in loss of consciousness, a sharp violation of spatial orientation, a disorder of coordination. The patient often and suddenly falls, his gait becomes unsteady and uncertain.

The signs of the disease become more noticeable with age, when the worsening of hemodynamics grows with the appearance of age-related changes 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 level C1 through the large opening of the occiput.

Intracranial or intradural v4 segment rises in front from the medulla oblongata, reaches the median line, where it joins the contralateral vertebral artery, forming a basilar vessel.

Most specialists do not share this segmentation, as it is specific in terms of clinical manifestations. The expressed symptomatic differences can be observed only with obvious disorders of individual brain functions, since the blood from the subclavian artery feeds its different parts. Therefore, the ischemic processes at different sites lead to different consequences and complications. In this case, the clinic 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 can remain hidden and do not manifest themselves throughout life. This is the most favorable form of the disease. Often, it is learned about it by accident, during routine diagnostics, or when addressing a doctor about other diseases.

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

Hypoplasia of the right vertebral artery in children

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

In childhood, small 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 great compensatory capabilities, the violation is imperceptible and does not cause the child problems.

With the course of age, other pathologies associated with the vascular system may occur. This puts additional strain on the affected artery: and only then signs of the disease begin to find themselves in one form or another. The patient begins to complain of dizziness (sometimes - with nausea), numbness of limbs, change of coordination, problems with vision. But all these signs are manifested already at a later age

Complications and consequences

Hypoplasia usually does not manifest itself to a certain point, and sometimes throughout life: it all depends on the individual characteristics of the patient.

The probability of the appearance of adverse effects with hypoplasia of the right vertebral artery is impossible to predict. In most patients, pathology occurs against the background of many functional disorders from different organs and whole systems. Often there are difficulties with the diagnosis.

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

• violation of visual and auditory function;
• migraine headaches;
• state of fatigue, disability;
• depression, irritability, frustration on the part of the autonomic nervous system;
• thrombosis of the affected arteries;
• strokes, cerebral circulation disorders.
•  

[18], [19], [20], [21]

Diagnostics of the hypoplasia of the right vertebral artery

A diagnostic diagnosis will help to establish the correct diagnosis.

Analyzes include standard and specific studies:

• a standard blood test is performed to determine the number of erythrocytes, leukocytes, hemoglobin level, ESR, which gives information about the presence of inflammatory process in the body;
• specific analyzes allow to determine the level of different biological substances - enzymes, peptides, metabolites, etc.

For the diagnosis of hypoplasia, analyzes are of secondary importance: they are conducted to obtain general information on the state of the body.

Instrumental diagnostics consists of such 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 fixation with assessment of the state of the vertebral artery).
• Computer and magnetic resonance imaging with contrast enhancement of the image.

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

[22], [23], [24], [25]

Differential diagnosis

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

• with hyperplasia of the vertebral artery: a resistant low-velocity Doppler blood flow curve, the average time-limit blood flow velocity ≤14.8 cm / s, the diameter of the vertebral artery ≤2.3 mm with growth for a hypocupenchic sample ≤0.1 mm;
• with reflex spasm: a spiked split view of the 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 of the hypoplasia of the right vertebral artery

To facilitate the patient's condition with hypoplasia of the right vertebral artery, there are several ways:

1. Traditional medication. It provides for the use of drugs that positively influence the composition of blood, improve blood circulation in the cerebral vessels and accelerate the metabolism. Medications will not lead to a complete cure, but will help prevent a critical deterioration in the condition. As a rule, as drugs prescribe drugs acetylsalicylic acid, Thiocytes, Ceraxon, Trental, Cinnarizine, Actovegin, Cerebrolysin, Vinpocetine, etc.
2. Operative intervention. It is used only in extreme cases, after unsuccessful attempts to improve cerebral circulation with the help of conservative therapy. The operation is rather complicated - it is an endovascular intervention and is performed by neurosurgeons.

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

Medications

Name of the drug	Dosing and Administration	Side effects	special instructions
Cinnarizine	Assign 1 tablet three times a day.	Possible reactions such as drowsiness, dyspepsia, allergies.	Cinnarizine is better taken after a meal, to minimize irritation of the digestive tract.
Actovegin	Assign inside 1-2 lozenges three times a day before meals.	There may be sweating, fever, allergies.	In severe cases, parenteral administration of the drug is used.
Cerebrolysin	Enter intramuscularly or intravenously, after dilution in a solution of sodium chloride or in a 5% solution of glucose. Dosages are individual.	Rarely with rapid administration there is dizziness, pain in the head, tachycardia.	The drug is not used to treat patients with allergic diathesis and kidney failure.
Trental	Assign 2-4 tablets up to three times a day, or intravenously in the form of a solution - according to the indications.	Possible redness of the face, pain in the head, irritability.	Trental is used with caution for gastric ulcer, heart failure, and also in the postoperative period.
Vinpocetine	Assign 1-2 tablets three times a day, long.	Symptoms such as dizziness, nausea, reddening of the upper body, tachycardia are possible.	In severe cases, Vinpocetine is administered intravenously-drip.

Vitamins

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

• Retinol (A) - improves metabolism, prevents vascular damage by arteriosclerosis. Contained in fish oil, dairy products, carrots, pumpkin, Bulgarian pepper.
• Ascorbic acid (C) - prevents the formation of cholesterol plaques, strengthens the heart and vascular walls. Contained in berries, fruits, citrus.
• Routine (P) - makes the vascular wall strong. Contained in citrus, berries, dog rose.
• Tocopherol (E) - an antioxidant, improves fat metabolism and prevents intoxication. Contained in vegetable oils, eggs, nuts.
• Pyridoxine (B ₆ ) - removes excess cholesterol, stabilizes metabolic processes. Contained in fish, dairy products, brown rice, beans.

If the doctor recommends complex vitamin preparations, then you should pay attention to such means:

• Vitrum cardio;
• Doppel Hertz cardio system-3;
• Vitalariks cardio;
• Cardio Forte;
• Centrum cardio.

Physiotherapeutic treatment

When hypoplasia of the right vertebral artery, physiotherapy is not a topical therapeutic method. However, its use helps to ease the patient's condition and eliminate some unpleasant signs of the disease.

Such physiotherapeutic effects are permissible:

• LFK - includes a set of exercises for the restoration of blood circulation, walking.
• Mud treatment - normalizes the activity of the nervous and cardiovascular system.
• Hydrotherapy, mineral water, contrast shower.
• Fresh baths with warm water - relax and soothe the nervous system.
• Dry carbon dioxide bath - promotes vasodilation and pressure reduction.

Improve the well-being of electrosleep, pine baths and other procedures. Standard course of physiotherapy lasts 10 days.

Alternative treatment

Treatment with alternative drugs, unfortunately, can not 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 alternative means will be applied against the background of the traditional treatment prescribed by the doctor.

• Pour into the thermos for six full tablespoons of dried berries hawthorn and grass motherwort. Pour 1500 ml of boiling water and leave overnight. In the morning, the infusion filtered and consumed 100 ml to 4 times a day.
• Squeeze out the juice from ten lemons. We clean five garlic heads, we pass the teeth through the press. Mix all the ingredients with a liter of honey, put in a jar, cover with a lid and put in the fridge for one week. After seven days, the medicine can be consumed: 4 tsp. For half an hour before dinner, gradually dissolving the mass in the mouth.
• In the diet must include dried apricots: it is recommended to eat 100-150 g each day. This will improve the condition of the heart and blood vessels.
• Prepare the broth from the beans from 1:10. We consume it 100 ml three times a day for 30 minutes before a meal. Decoction improves the heart, relieves edema, prevents atherosclerosis, normalizes blood pressure.
• We use natural honey for 1 tbsp. L. Three times a day. Honey can be planted in warm water or watered them with fruit.

Herbal Treatment

• Such a well-known plant, like a dandelion, perfectly stabilizes the level of cholesterol in the blood. For example, a powder from the rhizome of a dandelion is taken on a 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 atherosclerotic action, the leaves have anti-anemia and joint-protective activity.

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

To reduce the frequency of seizures, it is recommended that plants such as lemon balm, peppermint, marshmallow, mistletoe, gorichvet, bedstraw be included in herbal preparations.

Homeopathy

Along with medicines, homeopathic remedies are also used successfully, which the doctor appoints the appropriate direction. Homeopathy affects the body according to the principle of "treating like like". There are a number of drugs that positively affect vertebral arteries and cerebral vessels.

• Cholesterol - lowers cholesterol, improves the condition of blood vessels in atherosclerosis.
• Gold iodine - effective in atherosclerosis of cerebral vessels.
• Conium - helps with stroke and post-stroke states.
• Krategug - improves cerebral circulation.

With circulatory failure, complex homeopathic remedies can be used:

• Traumeel in the form of tablets and ointments;
• Objective T - in the form of tablets and ointments;
• Diskus compositum in the form of intramuscular injections.

The dosage of drugs is selected individually. Side effects are practically absent: only occasionally there is an allergic reaction to this or that drug - in isolated cases.

Surgery

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

Previously, for the improvement of the patient's condition, an extra-intracranial anastomosis was surgically applied. But such an operation was later found ineffective and lost its relevance.

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

1. Stenting - the introduction of a special "insertion" in the narrowed section of the vessel to prevent its further narrowing. Stents can be a mini-structure similar to a skeleton, which is often additionally impregnated with medicinal solutions to prevent thrombus formation and formation of cicatricial changes in the vessel.
2. Angioplasty is the restoration of the old form of the artery. During the operation, a mechanical action (as a rule, balloon expansion of the vessel) is applied to the narrowed section, which allows to restore the previous diameter of the lumen.
3. The operation of reconstructive orientation is the removal of the narrowed part of the vessel with its further prosthetics. As a prosthesis, a part of the patient's own vein, which is taken from other sites, is usually used. This operation is carried out only in the most severe cases.

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

After the operation, patients are prescribed blood-thinning therapy and special exercises to normalize the general circulation. Moderate physical load after surgery can prevent the formation of thrombi. However, the load should be just moderate: intensive training and lifting of weights in this period are contraindicated.

Prevention

Specific prevention of hypoplasia does not exist, because the exact cause of the disease scientists have not yet figured out. One can affirm unambiguously the following: during pregnancy a woman should observe the maximum possible healthy lifestyle, avoid the use of any medications, monitor her own health.

If a person already has hypoplasia of the vertebral artery, it is important to do everything possible to prevent acute circulatory disturbances in the brain. For this, it is necessary to regularly hold such events:

• monitor blood pressure;
• to control the level of cholesterol in the blood;
• follow the normal body weight, be physically active, abandon bad habits;
• periodically check the blood glucose level.

It is recommended to conduct monotherapy with antiaggregants - for example, acetylsalicylic acid in the amount of 325 mg per day, or clopidogrel.

Hypoplasia of the right vertebral artery and sport

Practically in all cases of hypoplasia of the right vertebral artery, sports are actual, and for some patients they are simply necessary. Nevertheless, some people who have learned about their illness often give up playing sports, because they are afraid to harm themselves.

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

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

[26], [27], [28], [29], [30]

Gymnastics with hypoplasia of the right vertebral artery

With regular practice of special gymnastics, you can achieve tangible results: normal blood circulation is restored, well-being improves, cheerfulness appears.

Of course, do not forget that gymnastics can not completely eliminate hypoplasia. However, with regular lessons about the disease can be "forgotten" for a long time.

The gym includes such exercises:

1. Sit down on a chair, holding a flat back. Relax your hands, lower them down. Ten times we turn our heads in one and the other direction, according to the maximum amplitude. If there is pain, then the movement is made more smoothly.
2. We remain in the same position. We lower head downwards and try to touch the chin to the chest. We stop for ten seconds. So we perform five repetitions.
3. We sit in a chair, our hands are relaxed. We pull our chin and try to move our head backwards. We repeat ten times.
4. Sitting on a chair, we put a palm of any hand to the forehead. We bend our head forward, leaning our forehead against the palm of our hand. We are delayed for ten seconds. We do ten repetitions.
5. We get straight, we relax our hands. We lift the shoulders extremely high, hold for ten seconds, then relax the shoulders, breathe deeply. Repeat up to ten times.
6. We lay down on the floor, on the back, raise our head, hold for ten seconds, return to the previous position. Repeat 8-10 times.

These exercises will help cope with unpleasant sensations in the neck and head, 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 an acute circulatory disorder in the brain, which requires a special approach to diagnosis and therapy.

The overall prognosis can not be unambiguous: it depends on the severity of the vessel's narrowing, on the degree of triggering of compensation mechanisms, on the presence of other diseases in the body.

If the patient does not notice a significant deterioration and does not make serious complaints, then the forecast is considered relatively favorable.

If the patient has expressed signs of vertebral-basilar insufficiency, then the prognosis in this case worsens. Surgery may be required, which in most cases gives good results.

[31], [32], [33], [34], [35], [36], [37]

Disability

The decision to award disability to a patient with hypoplasia of the right vertebral artery is taken by the specialized commission of the Ministry of Health. Disability is appointed not so much in view of the disease, but rather taking into account signs of impaired functions and decompensation of mechanisms that ensure normal life activity of a person. That is, if hypoplasia was detected during the diagnosis, but the patient feels well, and his complaints about health are not critical, he may be denied disability.

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

[38], [39], [40], [41], [42], [43]