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Vertebral Basilar Insufficiency - Causes and Pathogenesis
Last reviewed: 04.07.2025
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Causes of vertebrobasilar insufficiency
Dizziness may have an ischemic vascular nature, caused by a violation of 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. 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, vegetative-vascular dystonia, as well as after myocardial infarction in the presence of various forms of arrhythmia and cerebrovascular pathology.
A significant place in the structure of cerebrovascular diseases is occupied by acute and chronic circulatory disorders in the vertebral-basilar system, caused by developmental anomalies, stenosis and deformation of the vertebral arteries. In these cases, dizziness occurs in response to ischemia in various parts of the vertebral-basilar system, leading to damage to the vestibular analyzer (from the labyrinth to its cortical part).
In clinical practice, it is important to distinguish between peripheral vertigo caused by ischemic damage to the inner ear (labyrinth), the root of the VIII cranial nerve, and central vertigo caused by ischemia of the vestibular nuclei and pathways. Peripheral vertigo occurs much more often than central vertigo.
Pathogenesis of vertebrobasilar insufficiency
Considering that the anterior inferior cerebellar artery is involved in the blood supply of not only the anterolateral parts of the brainstem, the middle cerebellar peduncle, but also the inner ear; a change in the intensity of blood flow through this artery leads to the development of ischemia of the labyrinth and root of the VIII cranial nerve, vestibular nuclei and vestibulocerebellar tracts, and the development of an attack of dizziness. Clinical signs of an infarction in the basin of the anterior inferior cerebellar artery are described, before the development of which there were recurrent attacks of rotational dizziness. Dizziness appears as an isolated symptom long before the development of an infarction in the basin of the anterior inferior cerebellar artery, accompanied by hearing loss, noise in one ear, and ataxia. Unilateral auditory and vestibular disorders were confirmed by the results of an audiological and vestibulometric study. It has been shown that attacks of dizziness preceding infarction result from ischemia of the inner ear and vestibular nerve.