Vertebrobasilar insufficiency: symptoms

The patient complains of seizures of systemic or non-systemic dizziness that are accompanied by a balance disorder. Among the complaints are also nausea and vomiting, noise in the ear, hearing loss. Often seizures are recurrent, associated with fluctuations in blood pressure, turns and inclinations of the head, stress.

Vestibular dysfunction with circulatory failure in the vertebral-basilar system is manifested by a wide range of various clinical manifestations of peripheral cochleovestibular syndromes. Characteristic are attacks of systemic rotational dizziness that occur in elderly patients more often against arterial hypertension and combination with atherosclerosis, and in young patients against a background of vegetative-vascular dystonia ; Attacks are accompanied by acute unilateral neurosensory hearing loss, which proceeds in the form of an internal ear infarction. Attacks of dizziness are isolated or combined with other otoneurological manifestations and hearing loss, and sometimes as a type of attack of Meniere's disease.

The onset of the disease is characterized by the development of an acute attack of systemic dizziness with nausea, vomiting, a balance disorder, sometimes a brief loss of consciousness. Before the onset of a dizziness, some patients notice the appearance of noise and hearing loss, more often more pronounced on the one hand, in a number of cases auditory disorders are not very pronounced and are characterized by patients as a violation of speech intelligibility. Relapses of dizziness attacks are associated with increased or fluctuating blood pressure, head and torso rotations, and changes in body position.

An analysis of observations and data from the literature made it possible to conclude that there are anatomical and physiological prerequisites against which a peripheral cochleovestibular syndrome is formed. These include anomalies of vertebral arteries, such as asymmetry of diameters, hypoplasia of the vertebral artery to the right or left, the absence of posterior connective arteries.

According to the data of ultrasonic methods of investigation of blood flow along the main arteries of the head (ultrasonic dopplerography, duplex scanning, transcranial dopplerography and magnetic resonance angiography), structural changes in the vertebral arteries are characterized by deformations (usually unilateral), hypoplasia, and stenosis and occlusion in isolated cases. The revealed changes in the structure of these arteries cause chronic insufficiency of blood flow in the vertebral-basilar system,

Deformations and stenoses of the internal carotid arteries also occur in a significant number of cases, which indicates the frequency of combination of lesions of vertebrates and internal carotid arteries in the group of patients with arterial hypertension. Vestibular dysfunction in combination with mild auditory disorders (noise and stuffiness in the ear) in patients with bilateral lesions of the internal carotid arteries (occlusion and critical stenosis) are the only clinical manifestation of carotid basal involvement.

In connection with the fact that patients with vestibular dysfunction of vascular genesis often suffer from arterial hypertension and atherosclerosis, an important point is the study of their blood pressure and the state of central hemodynamics.

More often patients with peripheral cochleovestibular syndrome have a "soft" form of arterial hypertension, relatively stable figures of central hemodynamics; with a decrease in the magnitude of the shock and minute volume of blood, which contributes to circulatory failure in the vertebral-basilar system.

Cochleovestibular disorders in vertebral-basilar vascular insufficiency.

Causes and pathogenesis. The causes of vertebral-basilar vascular insufficiency are spondyloarthrosis and osteochondrosis of the cervical spine, pathological tortuosity, loop formation, compression, atherosclerotic narrowing of the vertebral arteries, irritation of the sympathetic plexus of the vertebral arteries with osteophytes in the holes of the transverse processes of the cervical vertebrae, etc. All these factors ultimately lead to degenerative changes and thromboembolism of the vertebral arteries, as well as to the reflex spasm of terminal vessels that depart from the bases lar artery, including branches of the labyrinthine artery. These factors are the cause of ischemic events in VU and the development of a complex of cochleovestibular disorders, close in their clinical picture to Meniere's syndrome.

Labyrinth angiovertebrogenic syndrome manifests itself in the following clinical forms:

1. erased forms with indefinite subjective symptoms, characterized by gradual, year by year, increasing hearing loss (one- or two-sided), the appearance of interlabyrinth asymmetry, first along the peripheral and then the central type, increasing the sensitivity of the vestibular apparatus to accelerations and optokinetic stimuli; over time, this form progresses to spontaneous vestibular crises and the neurological stage of vertebral-basilar vascular insufficiency;
2. frequent sudden, lesser-like crises arising from the absence of any cochleovestibular disturbances; Gradually, with this form, one-sided or two-sided hearing loss occurs according to the type of disturbance of sound perception and hypofunction with interlabyrinth asymmetry of the vestibular apparatus;
3. sudden attacks of spatial discoordination with a short darkening of consciousness, loss of balance and unpredictable falls;
4. persistent prolonged vestibular crises (from several hours to several days), combined with tabloid or diencephalic disorders.

Symptoms of labyrinth angiovertebrogenic syndrome are determined by its form. With erased forms, by the end of the working day, there is a noise in the ears, light directed (systemic) dizziness, unstable balance when walking down the stairs or with a sharp turn of the head. In the early stages of the disease, when the angiodystonic processes affect only the structures of the inner ear, and the blood supply to the brain stem is compensated, the compensatory-adaptive processes prevail in the patient's condition, allowing him to recover within two to three days of rest. With the spread of vascular disorders to the brain stem, in which the auditory and vestibular centers are located, the processes of cochlear and vestibular decompensation begin to predominate and the disease passes into the stage of persistent labyrinthine dysfunctions and transient neurologic symptoms. At this stage, in addition to the interlabyrinth asymmetry revealed by the provocative vestibular probes, one-sided and then the other ear develops hypoacusis along the peripheral and then the central type.

The occurrence of persistent and prolonged vestibular seizures is caused not only by angiodystonic crises in the basin of the vertebral-basilar vascular system, but also by gradually arising organic changes in the ears labyrinth similar to those that arise in the II and III stages of Menier's disease (fibrous membranous labyrinth, narrowing of endolymphatic spaces, up to complete desolation of them, degeneration of the vascular stripe, etc.), which lead to a chronic irreversible labyrinth hydrops and degeneration its hair (receptor) cells. With the defeat of the cervical spine are associated two well-known syndrome - Barre-Liu.

The Barre-Leuux syndrome is defined as a neurovascular symp- tomoplex that occurs with cervical osteochondrosis and deforming spondylosis of the cervical spine: headache, usually in the occipital region, dizziness, imbalance in standing and walking, noise and pain in the ears, visual and accommodation disorders, neuralgic pain in the eye area, arterial hypothesis in the vessels of the retina, facial pain.

Berci-Roshena syndrome is defined as a neurovegetative symptom complex in patients with diseases of the upper cervical vertebrae: a one-sided paroxysmal headache and paresthesia in the face, tinnitus and photopsy, scotoma, difficulty in the movements of the head. The spinous processes of the upper cervical vertebrae are sensitive to palpation. When the head tilts to one side, the pain in the neck on the other side increases. X-ray picture of osteochondrosis, traumatic injury or other type of lesion (eg, tuberculosis spondylitis) of the upper cervical vertebrae.

The diagnosis of the labyrinthine angiovertebrogenic syndrome is based on the results of an x-ray examination of the cervical spine of the spine, REG, dopplerography of the cerebral vessels, and, if necessary, brachiocephalic angiography. Of great importance are the data of the patient's interview and his complaints. The overwhelming majority of patients suffering from labyrinthine angiovertebrogenic syndrome note that when the head rotates, dizziness appears or increases, a feeling of nausea, weakness, instability on standing or walking occurs. Discomfort in these patients occurs when watching movies, television broadcasts, driving in transport. They do not tolerate sea and air, pitching, drinking, smoking. The main significance in the diagnosis of labyrinth angiovertebrogenic syndrome is given to vestibular symptoms.

Vertigo is the most common symptom observed in 80-90% of cases.

Cervical positional nystagmus usually occurs when the head is tilted backward, in the direction opposite to that vertebral artery in which more pronounced pathological changes are observed.

Violation of coordination of movements is one of the typical signs of vertebral-basilar vascular insufficiency and depends not only on the violation of the function of one of the vestibular apparatus, but also on vestibulo-cerebellar-spinal discoordination caused by ischemia of the stem, cerebellar and spinal motor centers.

Differential diagnosis of the labyrinthine angiovertebrogenic syndrome is very complex, because unlike Meniere's disease, for which there is typically no apparent cause, vertebrogenic labyrinthopathy can be based, in addition to the above reasons, for a variety of neck disorders such as cervical spine and spinal cord injuries and their consequences , cervical osteochondrosis and deforming spondylarthrosis, cervical ribs, giant cervical processes, tuberculous spondylitis, rheumatic affection of the joints of the spine, cervical impaired ganglionitis, various abnormalities of the development of the skull, brain and spinal cord, for example, Arnold-Chiari syndrome (a hereditary syndrome caused by brain abnormalities: the downward movement of the cerebellum and medulla oblongata with cerebrospinal fluid dynamics and hydrocephalus-and manifested by occlusive hydrocephalus, cerebellar disorders with ataxia and nystagmus, signs of compression of the brain stem and spinal cord (paralysis of the cranial nerves, diplopia, hemianopsia, tetanoid attacks x or epileptiform seizures, often anomalies skull and cervical vertebrae) and m. N. It should not be excluded from the differential diagnosis of pathological processes such as labyrinth angiovertebrogenny syndrome and bulk processes in the posterior cranial fossa, lateral cerebral tank petrous. The presence of chronic purulent otitis media should also be considered as a possible cause of chronic limited labyrinthitis or labyrinthosis, possibly, cystic arachnoiditis of MMU with compression syndrome. It should also take into account the possibility of the presence of diseases such as syringobulbia, multiple sclerosis, various cerebral vasculitis, which often occur with atypical forms of "labyrinthopathy".

Treatment of patients suffering from labyrinthine angiovertebrogenic syndrome, complex, pathogenetic - is aimed at restoring the normal blood supply to the inner ear, symptomatic - to block pathological reflexes that emanate from the pathological effects of nervous structures. It is performed in neurological hospitals under the supervision of an otoneurologist and a surdologist.