Vertebrobasilar insufficiency physical examination
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Differentiating Vertebrobasilar insufficiency from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical Examination
Physical examination of VBI isn't enough to diagnosis the disease.Normally,phsician can take several items below:
- Vital signs: In some cases, pulses and blood pressure should be checked in both arms. Most patients with subclavian steal syndrome, which can also cause vertebrobasilar artery insufficiency, have pulse or systolic blood pressure differences between the two arms[1]
- auscultated on neck: The vertebral artery bruitscan be found by auscultated,which suggest atherosclerosis.
- eyes: Positional nystagmus, induced by rapidly changing the position of the head,strongly suggests an organic vestibular balance disorder caused by central nervous system. Internuclear ophthalmoplegia, unreactive pupils, skew deviation, hemianopia, and cortical blindness suggests an vertebrobasilar ischemia.[2]
- Positional testing:If no Positional nystagmus was observed, we can choose the positional testing.In the Hallpike maneuver, patients are moved quickly from an upright seated position to a supine position and the head is turned to one side and extended (to a head-down posture) approximately 30 from the horizontal plane off the end of the stretcher. The eyes should be observed for Positional nystagmus, and patients should be queried for the occurrence of symptoms.This test should be repeated with the head turned to the other side.[1] This test should be performed with caution because of the risk of suddenly dropping of atheromatous plaques.
- other:Some patients are obseved to have right arm weakness and expressive aphasia.
References
- ↑ 1.0 1.1 Schneider JI, Olshaker JS (2012)Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke.Emerg Med Clin North Am 30 (3):681-93. DOI:10.1016/j.emc.2012.06.004 PMID: 22974644
- ↑ Searls DE, Pazdera L, Korbel E, Vysata O, Caplan LR (2012) and signs of posterior circulation ischemia in the new England medical center posterior circulation registry. Arch Neurol 69 (3):346-51.DOI:10.1001/archneurol.2011.2083 PMID: 22083796