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Vertebral-basilar insufficiency
Last reviewed: 04.07.2025
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Vertebrobasilar insufficiency (vestibular dysfunction of vascular genesis, cerebrovascular insufficiency) is a disorder of vestibular function associated with circulatory disorders in the central or peripheral parts of the vestibular analyzer.
ICD-10 code
- H81 Vestibular function disorders.
- H82 Vestibular syndromes in diseases classified elsewhere,
Epidemiology of vertebrobasilar insufficiency
Complaints of dizziness are made by about 30% of the population, and women twice as often as men. Dizziness often occurs against the background of vascular pathology of the brain, in patients with arterial hypertension, atherosclerosis, pathology of the main arteries of the head and vegetative-vascular dystonia. Of these patients, 47% had ear diseases. In patients with vegetative-vascular dystonia syndrome, dizziness is observed in 58-71% of cases.
[ What causes vertebrobasilar insufficiency?
Vertebrobasilar insufficiency may have an ischemic vascular nature, caused by impaired blood circulation in the arteries that feed the inner ear, which leads to ischemia of the labyrinth. Differential diagnostics of these diseases is extremely important, since only a timely and correct diagnosis allows for pathogenetic treatment and prevention of vascular diseases of the inner ear. Vertebrobasilar insufficiency often occurs against the background of vascular pathology of the brain in patients with arterial hypertension, atherosclerosis, pathology of the main arteries of the head, vegetative-vascular dystonia, as well as after myocardial infarction in the presence of various forms of arrhythmia and cerebrovascular pathology.
Symptoms of vertebrobasilar insufficiency
The patient complains of attacks of systemic or non-systemic dizziness, which are accompanied by a balance disorder. Complaints also include nausea and vomiting, tinnitus, and hearing loss. Vertebrobasilar insufficiency is often recurrent in nature, associated with fluctuations in blood pressure, head turns and tilts, and stress.
Vertebrobasilar insufficiency is manifested by a wide range of various clinical manifestations of peripheral cochleovestibular syndromes. Attacks of systemic rotational vertigo are characteristic, which occur in elderly patients more often against the background of arterial hypertension and combination with atherosclerosis, and in young patients - against the background of vegetative-vascular dystonia; attacks are accompanied by acute unilateral sensorineural hearing loss, occurring as an inner ear infarction. Attacks of vertigo can be isolated or combined with other otoneurological manifestations and hearing loss, and sometimes as an attack of Meniere's disease.
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Classification of vertebrobasilar insufficiency
Vertebrobasilar insufficiency is classified depending on the level of damage.
- Lesions at the peripheral level:
- labyrinthine;
- radicular.
- Central level defeat:
- subtentorial (nuclear, subnuclear, supranuclear);
- supratentorial (diencephalic-hypothalamic, subcortical, cortical).
Classification of the disease depending on the phase and degree of compensation of the vestibular function involves dividing vestibular disorders into compensated and decompensated.
All vestibular changes can be divided into two groups.
- Local vestibular symptoms. All focal vestibular disorders (peripheral, stem, cortical-subcortical) occur asymmetrically.
- General cerebral vestibular symptoms, represented by symmetrical spontaneous and experimental vestibular reactions. Characteristic is the topicality of all types of nystagmus or the loss of the fast phase of caloric and optokinetic nystagmus.
How is vertebrobasilar insufficiency recognized?
The characteristics of cochleovestibular disorders are based on the diagnosis of peripheral cochleovestibular syndromes of vascular genesis. Most of the examined patients had bilateral spontaneous nystagmus and only in isolated cases - unilateral. Unilateral nystagmus is usually combined with a harmonious deviation of the arms and trunk towards the slow component of nystagmus, which is typical for peripheral cochleovestibular syndrome in the acute period of the disease. The presence of bilateral nystagmus indicates simultaneous ischemic damage to the peripheral and central vestibular structures. Analysis of the symptoms of combined damage to the inner ear and brain structures (medulla oblongata, pons, midbrain, cerebellum, cerebral hemispheres) showed that in 80% of cases, peripheral cochleovestibular syndrome was formed against the background of symptoms of pons damage.
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How is vertebrobasilar insufficiency treated?
Vertebrobasilar insufficiency should be treated according to the following scheme: treatment of the underlying disease (arterial hypertension, atherosclerosis, vegetative-vascular dystopia, stenosis and occlusion of the main arteries of the head, etc.), treatment of peripheral and central dizziness. In order to improve cerebral circulation, it is recommended to use vasodilators (vinpocetine, pentoxifylline, cinnarizine, etc.), neuroprotectors (memantine, choline alfoscerate), nootropics (cerebrolyein, gamma-aminobutyric acid, piracetam, cortexin, etc.).