Vertebro-basilar Insufficiency

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

• 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

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

• 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

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