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Vertebrobasilar insufficiency: treatment
Last reviewed: 23.04.2024
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The goals of treatment of vertebral-basilar insufficiency are improvement of cerebral hemodynamics for elimination of central and peripheral vestibular disorders.
Indications for hospitalization
If a patient has an acute attack of dizziness with nausea and rigigo, which lasts more than 24 hours, hospitalization is recommended for the purpose of accurate diagnosis of the lesion of the labyrinth or brain and the carrying out of pathogenetic therapy.
Non-drug treatment of vertebral-basilar insufficiency
Non-drug treatment, which consists in carrying out vestibular gymnastics and classes on the stabilometric platform, is recommended to be performed after reducing the intensity of dizziness and combined with drug treatment.
Drug treatment of vertebral-basilar 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 vasodilating drugs (vinpocetine, pentoxifylline, cinnarizine, etc.), neuroprotectors (memantine, choline alfoscerate), nootropics (cerebrolyine, gamma-aminobutyric acid, pyracetam, cortexin, etc.).
Currently, as a universal vestibulitic for the elimination of vertigo of peripheral and central genesis, it is recommended to use a preparation of beta-histidine in a dose of not less than 48 mg per day. The pharmacological effect of betagistin is based on the fact that it activates microcirculation, increased blood flow in the basilar artery system and arteries of the inner ear. In addition, betahistine is an H1 receptor agonist involved in the stimulation of vestibular nuclei neurons responsible for central vestibular compensation. It blocks H3 receptors, stimulates postsynaptic histamine receptors both in the inner ear region and in the brain stem structures.
The effectiveness of treatment is confirmed by positive results of the dynamics of the vestibular function after the course of treatment obtained with computer electrostimagmography.
A comparative assessment of the efficacy of vasobral (dihydroergocryptin + caffeine) and betagistin allows one to note the more pronounced and quicker effect of treatment of vertigo on betahistine and the advantage of vasobral for the treatment of auditory disorders. The more pronounced effect of betahistine treatment is due to the fact that this drug has both a vasodilating action and a neuromodulatory action that promotes vestibular compensation. Peripheral vestibular syndrome due to circulatory insufficiency in the vertebro-basilar system is well suited for treatment with betahistine, but provided it is used for a long time. This should be taken into account when determining the tactics of treatment of patients with vestibular dysfunction.
[1], [2], [3], [4], [5], [6], [7]
Surgical treatment of vertebral-basilar insufficiency
Indication for surgical treatment is the presence of ischemic vestibular syndrome caused by stenosis of the vertebral, subclavian or internal carotid arteries. Conducts zondovascular stenting of the above arteries in a neurosurgical vascular compartment. In addition, in patients with frequent attacks of recurrent peripheral vertigo against the background of one-sided deafness and in the absence of the effect of drug therapy, one-sided neurotomy of the VIII cranial nerve or laserogenesis of the structures of the inner ear is performed.
Further management
To prevent recurrence of attacks of dizziness, it is recommended that patients should be examined at the otoneurologist at least 1-2 times per year and preventive courses of treatment should be conducted.
Information for patients
In the interictal period of the disease, it is recommended to monitor blood pressure and, when increasing it, to carry out a constant antihypertensive therapy prescribed by a neurologist or cardiologist. Systematically 1-2 times a year should take vasodilator and nootropic drugs. It should also avoid heavy physical exertion, prolonged exposure to the sun, forced head positions.
Forecast
The forecast is favorable. Approximate terms of incapacity for work are from 3 weeks to 3 months and depend on the effectiveness of central compensatory reactions.
[8], [9], [10], [11], [12], [13], [14]
Prophylaxis of vertebral-basilar insufficiency
Prevention of development in patients with arterial hypertension, atherosclerosis and deformations of arterial vessels of the head.