Vertebral-basilar insufficiency

Vertebral-basilar insufficiency (vestibular dysfunction of vascular genesis, discirculatory encephalopathy) is a violation of the vestibular function associated with circulatory disorders in the central or peripheral parts of the vestibular analyzer.

ICD-10 code

• H81 Violations of the vestibular function.
• H82 Vestibular syndromes in diseases classified elsewhere,

Epidemiology of vertebral-basilar insufficiency

Complaints about dizziness are made by about 30% of the population, and women are twice as likely 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. Out of 47% of these patients had ear diseases. In the syndrome of vegetative-vascular dystonia in patients, dizziness is observed in 58-71% of cases.

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What causes vertebral-basilar insufficiency?

Vertebral-basilar insufficiency may have an ischemic vascular nature, caused by a violation of blood circulation in arteries feeding the inner ear, which leads to labyrinth ischemia. Differential diagnosis of these diseases is extremely important, since only a timely and correctly established diagnosis allows for pathogenetic treatment and prevention of diseases of the inner ear of vascular genesis. Vertebral-basilar insufficiency often occurs against the background of cerebral vascular pathology in patients with arterial hypertension, atherosclerosis, the pathology of the main arteries of the head, vegeto-vascular dystonia, and after myocardial infarction in the presence of various forms of arrhythmias and cirdial pathology.

Symptoms of vertebral-basilar insufficiency

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, vertebral-basilar insufficiency is recurrent, associated with fluctuations in blood pressure, turns and inclinations of the head, stress.

Vertebral-basilar insufficiency manifests itself in 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.

Classification of vertebral-basilar insufficiency

Vertebral-basilar insufficiency is classified according to the level of the lesion.

• Defeat at the peripheral level:
  • labyrinth;
  • radicular.
• Defeat at the central level:
  • subtentorial (nuclear, subnuclear, supernuclear);
  • supratentorial (diencephalic-hypothalamic, subcortical, cortical).

Classification of the disease, depending on the phase and the degree of compensation of the vestibular function, provides for the division of vestibular disorders into compensated and decompensated ones.

All vestibular changes can be divided into two groups.

• Local vestibular symptoms. All focal vestibular disorders (peripheral, stem, cortical-subcortical) proceed asymmetrically.
• General cerebral vestibular symptoms, represented by symmetrical spontaneous and experimental vestibular reactions. The topicality of all types of nystagmus or prolapse of the fast phase of the caloric and optokinetic nystagmus is characteristic.

[7], [8], [9], [10], [11], [12], [13]

How is vertebral-basilar insufficiency recognized?

On the basis of diagnostics of peripheral cochleovestibular syndromes of vascular genesis, there are features of cochleovestibular disorders. The majority of the examined patients had bilateral spontaneous nystagmus and only single cases - one-sided. One-sided nystagmus is usually combined with a harmonious deviation of the arms and torso towards the slow component of the nystagmus, which is characteristic of the peripheral cochlear-vestibular syndrome in the acute period of the disease. The presence of bilateral nystagmus indicates a simultaneous ischemic injury of peripheral and central vestibular structures. Analysis of the symptoms of combined damage to the inner ear and brain structures (medulla oblongata, variolium bridge, middle brain, cerebellum, large hemispheres) showed that in 80% of cases peripheral cochleovestibular syndrome was formed against the background of symptoms of lesions of the variolium bridge.

How is vertebral-basilar insufficiency treated?

Vertebral-basilar 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 vasodilating drugs (vinpocetine, pentoxifylline, cinnarizine, etc.), neuroprotectors (memantine, choline alfoscerate), nootropics (cerebrolyine, gamma-aminobutyric acid, pyracetam, cortexin, etc.).