Vertebral artery syndrome

Diseases of the nervous system are inextricably linked with vascular diseases, because neurological pathologies often involve symptoms such as dizziness, headaches, fatigue, a feeling of "flies" before the eyes, and disturbances of consciousness. One of these vascular pathologies is vertebral artery syndrome - a painful condition that not only negatively affects the patient's ability to work, but also significantly worsens the quality of life.

Causes vertebral artery syndrome

In most cases, vertebral artery syndrome is caused by painful changes in the spine, in the muscular framework surrounding the spinal column. Also, various diseases of the arterial vessels themselves are a provoking factor.

Thus, we can identify the main possible causes of the development of the syndrome:

• congenital vascular anomalies (tortuous, narrowed arteries, pathological bends, etc.);
• diseases in which narrowing of the arterial lumen is observed (atherosclerotic changes in blood vessels, angiitis and vasculitis, vascular thrombosis and thromboembolism);
• the influence of external causes on the lumen of the artery ( cervical osteochondrosis, mechanical injuries to the spine, curvature of the spine, tumor processes, muscle spasms, cicatricial tissue tension).

It is worth noting that the left vertebral artery syndrome occurs more often than the right one. This is due to the fact that anatomically the left artery comes out of the aortic arch area, which most often suffers from atherosclerotic changes. In addition, osteochondrosis is often found in this area, which occurs with dystrophic and degenerative changes in tissues. With osteochondrosis, the arterial vessel is compressed by bone growths - osteophytes, as a result of which blood circulation in the brain significantly worsens.

Although right vertebral artery syndrome is less common, several of the above reasons can lead to its occurrence. In this case, the patient experiences a marked deterioration in well-being, which is especially noticeable with sharp head movements.

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Pathogenesis

Blood circulation in the brain is carried out thanks to the blood flow from four arterial vessels: a pair of common carotid arteries and a pair of vertebral arteries - left and right.

The main volume of blood flow is passed through the carotid arteries, so most strokes develop due to circulatory disorders in these vessels. The vertebral arteries have a significantly lower throughput, and a violation of blood flow in them does not pose a risk to life, but significantly worsens its quality.

Any significant change in blood flow through the vertebral arteries leads to increasing signs of cerebral hypoxia, which cannot but affect its functionality.

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Symptoms vertebral artery syndrome

The first signs of vertebral artery syndrome are constant, debilitating headaches, pulsating, localized in the occipital region.

With the onset of an attack of pain, other areas of the head are often affected, for example, the forehead-bridge of the nose area, or the temporo-parietal area.

Pain in vertebral artery syndrome is constant or increases in attacks. The skin in the painful area often becomes sensitive: even a slight touch can cause very unpleasant sensations.

When moving the head, a specific crunch is often heard: the patient feels tingling and discomfort in the neck. Sometimes the condition is accompanied by dizziness, dyspepsia, hearing and vision impairment. Some patients also complain of discomfort in the throat (feeling of a foreign body), difficulty swallowing food.

Additional non-specific symptoms include thirst, transient feeling of hunger, chills followed by fever.

Hearing loss in vertebral artery syndrome begins to manifest itself with a sensation of noise or ringing in the ears, dizziness. Hearing may decrease in only one ear, depending on the area of localization of the circulatory disorder. Disorders of the vestibular apparatus are observed at the same time.

Vertebral artery syndrome in pregnancy

During pregnancy, the load on the spine increases significantly. Moreover, its natural position changes, which entails tension in the muscles adjacent to the spinal column. All this, together with the vessels compressed by the enlarging uterus, affects the appearance of signs of vertebral artery syndrome.

As a rule, after childbirth the body gradually returns to normal, the condition of the spine is also restored, and the manifestations of the syndrome disappear. To speed up the stabilization of the position of the spinal column and relieve muscle spasm, it is recommended to undergo a course of manual therapy, massage and exercise therapy after childbirth.

Stages

In its development, vertebral artery syndrome has two stages.

• The functional (dystonic) stage is characterized by headaches that are present constantly, sometimes intensifying with movements or turns of the neck.

In addition, the dystonia stage is characterized by dizziness, both mild and severe, hearing and vision disorders. Evaluation of the fundus usually indicates decreased vascular tone.

• With further progression of the vertebral artery syndrome, the next stage, ischemic, comes after the dystonic stage. It is characterized by disorders of blood flow in the brain, which manifest themselves in the form of transient ischemic attacks. Such attacks are nothing more than attacks accompanied by dizziness, coordination disorders, dyspepsia, speech disorders. An attack can begin with another careless movement of the neck. After the attack, the patient becomes lethargic, weak, complains of ringing in the ears, flickering lights in the eyes, fatigue, headache.

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Complications and consequences

What is the danger of vertebral artery syndrome? With vertebral artery syndrome, there is a disorder of blood flow in the brain. This can manifest itself in the form of speech disorders, consciousness, and digestive function.

Progression of the pathological process can lead to a stable functional failure of the brain stem structures. In such a development of events, sharp attacks of the disease with short-term fainting states (about 10-15 minutes) occur.

The close relationship between the nerves passing close to the vertebral artery and the cardiovascular system in case of pathology can cause myocardial ischemia, and with repeated regular attacks, an infarction condition can develop.

Vertebral artery syndrome sometimes manifests itself as a disorder of the swallowing process, which can lead to respiratory dysfunction.

If vertebral artery syndrome is not treated, the patient’s condition will gradually worsen, until he or she is assigned the corresponding disability group.

A disorder of blood circulation in the brain can lead to acute ischemia or stroke, the patient becomes incapacitated and often loses the ability to care for himself independently.

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Diagnostics vertebral artery syndrome

Often, the diagnosis is established already during the preliminary examination of the patient by the doctor. The doctor palpates the painful areas in the occipital region, checks the amplitude of head movements and observes the patient's reaction.

In some cases, additional tests are prescribed. For example, a biochemical blood test can determine elevated cholesterol levels, which indicates atherosclerosis. A blood clotting test can help determine hypercoagulability and the body's tendency to increased thrombus formation.

Instrumental diagnostics may involve X-ray examination of the spine. It is especially important to examine the area from the first cervical vertebra to the occipital bone, as this area is the most common site of compression of the vertebral artery.

In addition, magnetic resonance imaging can be performed. This type of examination allows determining the presence of hernias, osteophytes, and disc protrusions. Additional use of contrast provides visualization of the lumen of the vertebral artery.

Less frequently, ultrasound examination of the cervical vessels is performed, which helps to identify defects within the vascular lumen.

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Differential diagnosis

Differential diagnosis is carried out with common migraine, due to the similarity of the clinical picture.

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Treatment vertebral artery syndrome

Since vertebral artery syndrome is a multi-symptom disease, its treatment should be carried out only in a complex manner.

The medications that a doctor may use to treat the syndrome should primarily be aimed at reducing swelling and inflammation in the tissues, as well as possibly widening the lumen of the artery.

	Dosage	Side effects	Special instructions
Baclofen	Take in quantities from 15 to 60 mg per day, in three doses.	Sleep disturbances, fatigue, shortness of breath, low blood pressure, swelling, urinary disorders.	Treatment with the drug is started and finished by gradually increasing and decreasing the dose. The drug cannot be stopped abruptly.
Actovegin	Prescribe 1-2 tablets three times a day before meals. Treatment continues for 1-1.5 months.	Fever, dermatitis (including allergic), changes in blood pressure, weakness.	In severe cases, the drug is administered by injection.
Vinpocetine	Take 1-2 tablets three times a day, after meals.	Sleep disturbances, stupor, tremors of the limbs, redness of the conjunctiva, anemia.	The drug is not used in pediatric practice.
Vasobral	Take ½-1 tablet twice a day. Treatment continues for up to 3 months.	Abdominal pain, sleep disturbances, dyspepsia.	Contains caffeine.
Nimesulide	Take 1 tablet twice a day after meals.	Stomach pain, heartburn, allergies.	Requires caution if you have any digestive system diseases.
Instenon	It can be used in tablets or injections. Tablets are taken 1-2 pcs. up to 3 times a day. The drug is injected 1 ml up to 3 times a day for 3-5 days.	Headache, facial flushing.	Not prescribed for epilepsy.

B vitamins are one of the components of proper treatment of vertebral artery syndrome. Vitamins such as thiamine (B1), nicotinic acid (B3), pyridoxine (B6) and cyanocobalamin (B12) participate in cellular metabolism, stimulate the work of neurons in the brain, and accelerate the transmission of nerve impulses.

In order to improve and facilitate the work of the brain, you can take the following vitamin preparations:

• Milgamma is a neurotropic vitamin preparation that is often prescribed for pathologies of the nervous and musculoskeletal systems. The drug is administered intramuscularly, 2 ml once a day, then every other day. During remission, an alternative use of Milgamma tablets is possible - 1 pc. three times a day.
• Neurobion is a combination of neurotropic vitamins, available in the form of injections and tablets. The drug is injected intramuscularly, 1 ampoule daily until the patient's condition is normalized. Tablets are taken 1 piece three times a day, with food.
• Neurovitan is a complex vitamin remedy for the treatment of diseases of the nervous system, arthralgia and myalgia. Usually 1 to 4 tablets are prescribed per day.

Physiotherapy treatment is used to accelerate blood circulation, stabilize vascular tone, normalize the central nervous system and support metabolic processes. The following procedures can help in the treatment of vertebral artery syndrome:

• electrophoresis of vasodilators and stimulating drugs, galvanization;
• electrophoresis with vasoconstrictors, contrast procedures;
• darsonvalization;
• electrosleep, franklinization, baths with pine needles, nitrogen;
• aerotherapy, thalassotherapy;
• transcerebral UHF therapy.

Massage for vertebral artery syndrome is used as an auxiliary treatment. During the massage, the brain receives signals that have a calming effect on the nervous system, which leads to the pain subsiding. The main technique of relaxing pain-relieving massage is stroking: light finger movements are used to stroke the skin of the face, as well as the parietal and occipital areas of the head. If other massage techniques are used, such as kneading or rubbing, the entire session is still finished with relaxing "flowing" movements.

Manual therapy helps relieve tension in the cervical spine and head muscles. This procedure consists of a whole complex of mechanical techniques that relieve pain, restore the range of motion in the neck, and regulate vascular tone. Manual therapy should not be identified with massage, as these are completely different therapeutic effects.

Osteopathy is one of the options of manual treatment, with the help of which it is possible to influence the circulation of cerebrospinal fluid, the quality of blood circulation. The osteopathic doctor carries out the impact on various zones of the cranium, in particular, on the area of the temples, the back of the head and the lower jaw, using minor pressing movements in time with the work of the respiratory system.

Acupuncture, unlike medications, allows you to stimulate your body's own defense, which involves the synthesis of special substances that direct all internal forces to fight the disease. This type of treatment is especially relevant for vertebral artery syndrome, as it eliminates muscle spasms and relieves pain. The introduction of the needle is absolutely painless. This procedure is carried out strictly according to indications and only by a specially trained medical specialist.

Homeopathy is prescribed only after the exact causes of vertebral artery syndrome have been determined. Only then can significant benefits from homeopathic remedies be expected.

For persistent pain, it is recommended to use dilution C6-C12. The medicine is taken in quantities of 6 to 8 granules up to 3 times a day. The duration of administration is at the discretion of the doctor, until the condition improves.

• Arnica - helps with pressure pain, brain injuries, as well as pain that depends on the position of the head or emotional state.
• Bryonia is suitable for patients with pulsating and twitching pains, which are accompanied by bouts of vomiting and dyspepsia.
• Chamomile - used to relieve the condition of patients who are particularly sensitive to any pain.
• Cocculus - can be used for pain in the occipital region, which is combined with dizziness and sleep disorders.
• Veratrum - will be effective for pain that is accompanied by loss of consciousness, sweating, especially when tilting the head or body forward.

Surgical treatment is used only in very extreme cases, if the narrowing of the vertebral artery becomes critical and poses a threat to the patient's life. The use of surgical intervention allows us to directly affect the cause of the syndrome, so the operation may involve removing a tumor, osteophyte, thrombus or other factor affecting the patency of the vertebral artery.

Treatment of vertebral artery syndrome at home

Self-treatment of vertebral artery syndrome usually involves performing exercises called isometric: during the exercises, the load falls on the upper limbs, while the neck and head remain motionless.

One of the exercises is designed to create lateral tension:

• place your palm on the temporal region and begin to press, while the neck should resist;
• performed first on one side, then on the other.

Similar exercises are performed when the palm is placed on the forehead and on the back of the head.

Before starting a series of classes, you need to know that at first some deterioration in the condition is allowed, which will subsequently normalize.

Folk remedies

The following popular remedies can be used as folk remedies:

• Three large heads of garlic are peeled, chopped and left in the refrigerator for three days. After that, the juice is filtered, an equal amount of honey and lemon juice is added. The remedy is drunk at night, 1 tbsp.
• Drink tea with added berries and fruits containing ascorbic acid (cranberries, currants, citrus fruits, sea buckthorn, etc.) as often as possible.
• Grate 0.5 kg of fresh chestnuts, pour water over them and leave in a cool place for 7 days. Filter the resulting solution and drink 1 teaspoon three times a day 30 minutes before meals.

Herbal treatment usually successfully complements traditional therapy. The patient's condition can be improved using the following recipe options:

• Prepare a mint infusion from 250 ml of boiling water and 1 full teaspoon of dry mint leaves. Infuse for 20 minutes. Drink 1/3 cup three times a day half an hour before meals.
• Take pasque flower herb (2 tsp), pour 250 ml of hot water and leave overnight. Strain in the morning and drink little by little throughout the day.
• Prepare an infusion of elder flowers - 250 ml of boiling water per 1 tbsp of flowers. Infuse for 30 minutes, filter. Drink the infusion with honey, 50-75 ml three times a day before meals.

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Exercises to Relieve Symptoms of Vertebral Artery Syndrome

Exercises aimed at relieving symptoms of vertebral artery syndrome will be of great benefit. For example, at all stages of the disease, you can practice the following exercises:

• rotations of the shoulder joints to the right and left, kneading of the neck muscles with the hands, swinging the arms up and down;
• free hanging arms with the back tilted forward and the neck relaxed;
• exercises with a skipping rope and a gymnastic bar, back bending and arching;
• swimming.

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Prevention

For preventive purposes, it is recommended to perform a series of physical exercises that will strengthen the back muscles. To perform the exercises, it is enough to devote 5-10 minutes to them every hour of work. This regime will help to relax the spasmodic muscles and accelerate the blood flow in the vascular bed.

During sleep, a person should feel as comfortable as possible. It is advisable to choose a special physiological orthopedic pillow that will give the head the most comfortable natural position during sleep.

The mattress should be no less comfortable – its softness should be medium-hard.

It is recommended to visit a massage therapist once or twice a year and have at least 10 massage sessions.

Sanatorium and resort treatment, fresh air, moderate physical activity and rest are also welcome.

Vertebral artery syndrome and sports

Patients suffering from vertebral artery syndrome are recommended moderate physical activity. Pilates, yoga, swimming, and simple gymnastic exercises are welcome.

Intensive physical activity, as well as professional sports, are not recommended. Classes in gyms, fitness clubs and sections should be carried out only under the supervision of a medical specialist.

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Forecast

Is a person suffering from vertebral artery syndrome fit for military service in the army?

There is no clear answer to this question, since everything depends on the degree of arterial patency and cerebrovascular accidents.

• If a patient complains of headaches, and there are no other signs of the disease, he may be called up for military service.
• If the syndrome is accompanied by dizziness, seizures are observed periodically, and there is a history of confirmed transient ischemic attacks, then such a person may be declared unfit for military service.

Disability may be assigned only to those patients whose condition is accompanied by transient ischemic attacks, with impaired motor activity and sensitivity, periodic or permanent deterioration of vision and hearing, dizziness and loss of consciousness. Such a condition must be confirmed by the presence of records in the patient's medical history and medical card.

In general, the prognosis for vertebral artery syndrome can be considered relatively favorable. If the disease results in a stroke or ischemia, the patient's condition worsens significantly, even to the point of disability. However, even such patients have fairly high chances of recovery.

If all the instructions and recommendations of doctors are followed, vertebral artery syndrome can be transferred to a stable period of remission, during which it is possible to lead a normal life, periodically visiting a doctor to monitor the condition.

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