===== VBI =====
**Vertebro-basilar Insufficiency**
[{{ :wiki:neurology:brainstemcirculationcns.png?300| **Brainstem circulation with Cranial Nerve approximation** }}]
  *a clinical syndrome caused by transient ischaemia of the vertebrobasilar circulation, formed by the vertebral and basilar arteries, which forms the posterior circulation of the brain.
    *vertebrobasilar arteries supply the cerebellum, medulla, midbrain, and occipital cortex
  *most commonly caused by atherosclerosis and/or embolism. Embolism is uncommon in vertebral arteries

=== Presentation ===
  *vertigo, dizziness,syncope, drop attacks
  *diplopia, visual field deficits, blindness
  *ataxia, imbalance, dysmetria are common
  *dysphagia, dysarthria are common
  *contralateral weakness
  *ipsilateral cranial N involvement when present

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**Vertebral artery STROKE is associated with a variety of syndromes**
  *Locked in syndrome
  *Lateral medullary syndrome
  *Internuclear ophthalmoplegia
  *Cerebellar infarction
  *Medial medullary syndrome
  *Posterior cerebral artery occlusion

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==== Management ====

  *as for TIA in general although vertebral artery TIA/stroke less commonly atherosclerotic in nature and endarterectomy/stent therefore less likely. The more distal from the brain the more likely.
  *angioplasty for basilar artery disease is not uncommon
  *as for TIA, prevention is key and risk stratification is central
    *control of hypertension, diabetes
    *management of arrhythmias
    *lipid lowering
    *blood thinners

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**References include:** \\  

https://radiopaedia.org/articles/vertebrobasilar-insufficiency?lang=gb \\  
https://www.ncbi.nlm.nih.gov/books/NBK482259/  \\  
http://www.dizziness-and-balance.com/disorders/central/strokes/tia.html \\