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Vertebral Basilar Insufficiency - Treatment
Last reviewed: 04.07.2025
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The goals of treatment of vertebrobasilar insufficiency are to improve cerebral hemodynamics to eliminate central and peripheral vestibular disorders.
Indications for hospitalization
If a patient experiences an acute attack of dizziness with nausea and riga that lasts more than 24 hours, hospitalization is recommended for the purpose of an accurate diagnosis of damage to the labyrinth or brain and pathogenetic therapy.
Non-drug treatment of vertebrobasilar insufficiency
Non-drug treatment, which consists of vestibular gymnastics and exercises on a stabilometric platform, is recommended to be carried out after the intensity of dizziness has decreased and combined with drug treatment.
Drug treatment of vertebrobasilar insufficiency
Treatment should be carried out 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.).
Currently, betahistine is recommended as a universal vestibulolytic to eliminate dizziness of peripheral and central genesis in a dose of at least 48 mg per day. The pharmacological effect of betahistine is based on the fact that it activates microcirculation, increases blood flow in the basilar artery system and arteries of the inner ear. In addition, betahistine is an agonist of H1 receptors involved in stimulating neurons of the vestibular nuclei responsible for central vestibular compensation. It blocks H3 receptors, stimulates postsynaptic histamine receptors both in the inner ear and in the brain stem structures.
The effectiveness of the treatment is confirmed by positive results of the dynamics of vestibular function after the course of treatment, obtained using computer electronystagmography.
Comparative evaluation of the effectiveness of vasobral (dihydroergocryptine + caffeine) and betahistine allows us to note a more pronounced and rapid effect of betahistine in treating dizziness and the advantage of vasobral in treating hearing disorders. A more pronounced effect of betahistine treatment is due to the fact that this drug has both a vasodilatory effect and a neuromodulatory effect, promoting vestibular compensation. Peripheral vestibular syndrome caused by circulatory insufficiency in the vertebrobasilar system responds well to treatment with betahistine, but only if it is used for a long time. This should be taken into account when determining the treatment tactics for patients with vestibular dysfunction.
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Surgical treatment of vertebrobasilar insufficiency
An indication for surgical treatment is the presence of ischemic vestibular syndrome caused by stenosis of the vertebral, subclavian or internal carotid arteries. Conducts endovascular stenting of the above arteries in the neurosurgical vascular department. In addition, in patients with frequent attacks of recurrent peripheral vertigo against the background of unilateral deafness and in the absence of effect from drug therapy, unilateral neurotomy of the VIII cranial nerve or laser destruction of the inner ear structures is performed.
Further management
To prevent recurrence of dizziness attacks, it is recommended that patients be examined by an otoneurologist at least 1-2 times a year and undergo preventive treatment courses.
Information for patients
During the interictal period of the disease, it is recommended to monitor blood pressure and, if it increases, to conduct constant hypotensive therapy prescribed by a neurologist or cardiologist. Vasodilators and nootropic drugs should be taken systematically 1-2 times a year. Heavy physical exertion, prolonged exposure to the sun, and forced head positions should also be avoided.
Forecast
The prognosis is favorable. The approximate period of disability is from 3 weeks to 3 months and depends on the effectiveness of central compensatory reactions.
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Prevention of vertebrobasilar insufficiency
Prevention of the development of arterial hypertension, atherosclerosis and deformation of the arterial vessels of the head in patients.