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*If the patient get an early diagnosis and treatment or not?
*If the patient get an early diagnosis and treatment or not?
For patients who experience vertebrobasilar [[transient ischemic attack]] portends a 30%to 35% risk for stroke during a 5-year period, whicih is higher than patients with carotid events in the acute phase, but that this is reversed in the subacute and chronic.<ref name="pmid609290">Cartlidge NE, Whisnant JP, Elveback LR (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=609290 Carotid and vertebral-basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota.] ''Mayo Clin Proc'' 52 (2):117-20. PMID: [http://pubmed.gov/609290 609290]</ref><ref name="pmid6538654">Heyman A, Wilkinson WE, Hurwitz BJ, Haynes CS, Utley CM, Rosati RA et al. (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6538654 Risk of ischemic heart disease in patients with TIA.] ''Neurology'' 34 (5):626-30. PMID: [http://pubmed.gov/6538654 6538654]</ref><ref name="pmid655661">Whisnant JP, Cartlidge NE, Elveback LR (1978) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=655661 Carotid and vertebral-basilar transient ischemic attacks: effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence--a population study.] ''Ann Neurol'' 3 (2):107-15. [http://dx.doi.org/10.1002/ana.410030204 DOI:10.1002/ana.410030204] PMID: [http://pubmed.gov/655661 655661]</ref>  In patients with clinically defi nite vertebrobasilar TIA, the absolute risk of stroke at 1 year was 17·1%.<ref name="pmid19293244">Marquardt L, Kuker W, Chandratheva A, Geraghty O, Rothwell PM (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19293244 Incidence and prognosis of > or = 50% symptomatic vertebral or basilar artery stenosis: prospective population-based study.] ''Brain'' 132 (Pt 4):982-8. [http://dx.doi.org/10.1093/brain/awp026 DOI:10.1093/brain/awp026] PMID: [http://pubmed.gov/19293244 19293244]</ref>  Medical refractory disease of the vertebrobasilar system carries a 5% to 11% risk of [[stroke]] or death at 1 year.<ref name="pmid12847074">Flossmann E, Rothwell PM (2003)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12847074 Prognosis of vertebrobasilar transient ischaemic attack and minor stroke.]''Brain'' 126 (Pt 9):1940-54. [http://dx.doi.org/10.1093/brain/awg197 DOI:10.1093/brain/awg197] PMID: [http://pubmed.gov/12847074 12847074]</ref>  Mortality associated with a [[stroke]] is high, ranging from 20% to 30%.<ref name="pmid12847074">Flossmann E, Rothwell PM (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12847074 Prognosis of vertebrobasilar transient ischaemic attack and minor stroke.] ''Brain'' 126 (Pt 9):1940-54.[http://dx.doi.org/10.1093/brain/awg197 DOI:10.1093/brain/awg197] PMID: [http://pubmed.gov/12847074 12847074]</ref>
For patients who experience vertebrobasilar [[transient ischemic attack]] portends a 30%to 35% risk for stroke during a 5-year period, whicih is higher than patients with carotid events in the acute phase, but that this is reversed in the subacute and chronic.<ref name="pmid609290">Cartlidge NE, Whisnant JP, Elveback LR (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=609290 Carotid and vertebral-basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota.] ''Mayo Clin Proc'' 52 (2):117-20. PMID: [http://pubmed.gov/609290 609290]</ref><ref name="pmid6538654">Heyman A, Wilkinson WE, Hurwitz BJ, Haynes CS, Utley CM, Rosati RA et al. (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6538654 Risk of ischemic heart disease in patients with TIA.] ''Neurology'' 34 (5):626-30. PMID: [http://pubmed.gov/6538654 6538654]</ref><ref name="pmid655661">Whisnant JP, Cartlidge NE, Elveback LR (1978) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=655661 Carotid and vertebral-basilar transient ischemic attacks: effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence--a population study.] ''Ann Neurol'' 3 (2):107-15. [http://dx.doi.org/10.1002/ana.410030204 DOI:10.1002/ana.410030204] PMID: [http://pubmed.gov/655661 655661]</ref>  In patients with clinically defi nite vertebrobasilar TIA, the absolute risk of stroke at 1 year was 17·1%.<ref name="pmid19293244">Marquardt L, Kuker W, Chandratheva A, Geraghty O, Rothwell PM (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19293244 Incidence and prognosis of > or = 50% symptomatic vertebral or basilar artery stenosis: prospective population-based study.] ''Brain'' 132 (Pt 4):982-8. [http://dx.doi.org/10.1093/brain/awp026 DOI:10.1093/brain/awp026] PMID: [http://pubmed.gov/19293244 19293244]</ref>  Medical refractory disease of the vertebrobasilar system carries a 5% to 11% risk of [[stroke]] or death at 1 year.<ref name="pmid12847074">Flossmann E, Rothwell PM (2003)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12847074 Prognosis of vertebrobasilar transient ischaemic attack and minor stroke.]''Brain'' 126 (Pt 9):1940-54. [http://dx.doi.org/10.1093/brain/awg197 DOI:10.1093/brain/awg197] PMID: [http://pubmed.gov/12847074 12847074]</ref>  Mortality associated with a [[stroke]] is high, ranging from 20% to 30%.<ref name="pmid12847074">Flossmann E, Rothwell PM (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12847074 Prognosis of vertebrobasilar transient ischaemic attack and minor stroke.] ''Brain'' 126 (Pt 9):1940-54.[http://dx.doi.org/10.1093/brain/awg197 DOI:10.1093/brain/awg197] PMID: [http://pubmed.gov/12847074 12847074]</ref>
<ref name="pmid7368245">Jones HR, Millikan CH, Sandok BA (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7368245 Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction.] ''Stroke'' 11 (2):173-7. PMID: [http://pubmed.gov/7368245 7368245]</ref><ref name="pmid13773892">MCDOWELL FH, POTES J, GROCH S (1961) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=13773892 The natural history of internal carotid and vertebral-basilar artery occlusion.] ''Neurology'' 11(4)Pt2 ():153-7. PMID: [http://pubmed.gov/13773892 13773892]</ref><ref name="pmid7210071">Patrick BK, Ramirez-Lassepas M, Synder BD (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7210071 Temporal profile of vertebrobasilar territory infarction. Prognostic implications.] ''Stroke'' 11 (6):643-8. PMID: [http://pubmed.gov/7210071 7210071]</ref>  Patients presenting with VB events are more likely to have a recurrent [[TIA]] than patients with carotid events.<ref name="pmid12847074">Flossmann E, Rothwell PM (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12847074 Prognosis of vertebrobasilar transient ischaemic attack and minor stroke.] ''Brain'' 126 (Pt 9):1940-54. [http://dx.doi.org/10.1093/brain/awg197 DOI:10.1093/brain/awg197] PMID: [http://pubmed.gov/12847074 12847074]</ref>
<ref name="pmid7368245">Jones HR, Millikan CH, Sandok BA (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7368245 Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction.] ''Stroke'' 11 (2):173-7. PMID: [http://pubmed.gov/7368245 7368245]</ref><ref name="pmid13773892">MCDOWELL FH, POTES J, GROCH S (1961) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=13773892 The natural history of internal carotid and vertebral-basilar artery occlusion.] ''Neurology'' 11(4)Pt2 ():153-7. PMID: [http://pubmed.gov/13773892 13773892]</ref><ref name="pmid7210071">Patrick BK, Ramirez-Lassepas M, Synder BD (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7210071 Temporal profile of vertebrobasilar territory infarction. Prognostic implications.] ''Stroke'' 11 (6):643-8. PMID: [http://pubmed.gov/7210071 7210071]</ref>  Patients presenting with VB events are more likely to have a recurrent [[TIA]] than patients with carotid events.<ref name="pmid12847074">Flossmann E, Rothwell PM (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12847074 Prognosis of vertebrobasilar transient ischaemic attack and minor stroke.] ''Brain'' 126 (Pt 9):1940-54. [http://dx.doi.org/10.1093/brain/awg197 DOI:10.1093/brain/awg197] PMID: [http://pubmed.gov/12847074 12847074]</ref>  If the basilar artery is occluated, the death or disability rate is close to 70%.<ref name="pmid23835026">van der Hoeven EJ, Schonewille WJ, Vos JA, Algra A, Audebert HJ, Berge E et al. (2013) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23835026 The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial.] ''Trials'' 14 ():200. [http://dx.doi.org/10.1186/1745-6215-14-200 DOI:10.1186/1745-6215-14-200] PMID: [http://pubmed.gov/23835026 23835026]</ref>
Algorithms using diffusion-weighted imaging(DWI) or CT-based scoring systems have been published for prognostic assessment of early ischemic injury in basilar artery occlusion to distinguish those patients who will most likely benefit from recanalization from those who will not.<ref name="pmid18617663">Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18617663 Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion.] ''Stroke'' 39 (9):2485-90. [http://dx.doi.org/10.1161/STROKEAHA.107.511162 DOI:10.1161/STROKEAHA.107.511162] PMID: [http://pubmed.gov/18617663 18617663]</ref><ref name="pmid18768716">Cho TH, Nighoghossian N, Tahon F, Némoz C, Hermier M, Salkine F et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18768716 Brain stem diffusion-weighted imaging lesion score: a potential marker of outcome in acute basilar artery occlusion.] ''AJNR Am J Neuroradiol'' 30 (1):194-8. [http://dx.doi.org/10.3174/ajnr.A1278 DOI:10.3174/ajnr.A1278] PMID: [http://pubmed.gov/18768716 18768716]</ref><ref name="pmid18480603">Renard D, Landragin N, Robinson A, Brunel H, Bonafe A, Heroum C et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18480603 MRI-based score for acute basilar artery thrombosis.] ''Cerebrovasc Dis'' 25 (6):511-6. [http://dx.doi.org/10.1159/000131668 DOI:10.1159/000131668] PMID: [http://pubmed.gov/18480603 18480603]</ref><ref name="pmid20562433">Terasawa Y, Kimura K, Iguchi Y, Kobayashi K, Aoki J, Shibazaki K et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20562433 Could clinical diffusion-mismatch determined using DWI ASPECTS predict neurological improvement after thrombolysis before 3 h after acute stroke?] ''J Neurol Neurosurg Psychiatry'' 81 (8):864-8. [http://dx.doi.org/10.1136/jnnp.2009.190140 DOI:10.1136/jnnp.2009.190140] PMID: [http://pubmed.gov/20562433 20562433]</ref>
Algorithms using diffusion-weighted imaging(DWI) or CT-based scoring systems have been published for prognostic assessment of early ischemic injury in basilar artery occlusion to distinguish those patients who will most likely benefit from recanalization from those who will not.<ref name="pmid18617663">Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18617663 Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion.] ''Stroke'' 39 (9):2485-90. [http://dx.doi.org/10.1161/STROKEAHA.107.511162 DOI:10.1161/STROKEAHA.107.511162] PMID: [http://pubmed.gov/18617663 18617663]</ref><ref name="pmid18768716">Cho TH, Nighoghossian N, Tahon F, Némoz C, Hermier M, Salkine F et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18768716 Brain stem diffusion-weighted imaging lesion score: a potential marker of outcome in acute basilar artery occlusion.] ''AJNR Am J Neuroradiol'' 30 (1):194-8. [http://dx.doi.org/10.3174/ajnr.A1278 DOI:10.3174/ajnr.A1278] PMID: [http://pubmed.gov/18768716 18768716]</ref><ref name="pmid18480603">Renard D, Landragin N, Robinson A, Brunel H, Bonafe A, Heroum C et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18480603 MRI-based score for acute basilar artery thrombosis.] ''Cerebrovasc Dis'' 25 (6):511-6. [http://dx.doi.org/10.1159/000131668 DOI:10.1159/000131668] PMID: [http://pubmed.gov/18480603 18480603]</ref><ref name="pmid20562433">Terasawa Y, Kimura K, Iguchi Y, Kobayashi K, Aoki J, Shibazaki K et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20562433 Could clinical diffusion-mismatch determined using DWI ASPECTS predict neurological improvement after thrombolysis before 3 h after acute stroke?] ''J Neurol Neurosurg Psychiatry'' 81 (8):864-8. [http://dx.doi.org/10.1136/jnnp.2009.190140 DOI:10.1136/jnnp.2009.190140] PMID: [http://pubmed.gov/20562433 20562433]</ref>


Latest revision as of 19:13, 11 December 2013

Vertebrobasilar insufficiency

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Natural History, Complications and Prognosis

Natural History

Some VBI is caused by the embolus from subclavian artery or atherosclerotic lesions and dissection, etc. Once the blocked vertebral artery doesn't get enough compensation from the contralateral, obviously multiple and multifocal infarcts in the brain stem, cerebellum symptoms will be observed immediately,and quickly develop to a severe outcome. Some patients present nonspecific symptoms, such as nausea, tinnitus, hearing impairment, and vertigo, which can precede the onset of the monophasic, progressive deficits by days, but typically by several weeks.

Prognosis

The prognosis of VBI vary depending on the severity of symptoms the patients present, such as:

  • Severe stroke or TIA?
  • The type of stroke?Ischemic and hemorrhagic?
  • The size and location of infarction or hemorrhage?
  • If the patient get an early diagnosis and treatment or not?

For patients who experience vertebrobasilar transient ischemic attack portends a 30%to 35% risk for stroke during a 5-year period, whicih is higher than patients with carotid events in the acute phase, but that this is reversed in the subacute and chronic.[1][2][3] In patients with clinically defi nite vertebrobasilar TIA, the absolute risk of stroke at 1 year was 17·1%.[4] Medical refractory disease of the vertebrobasilar system carries a 5% to 11% risk of stroke or death at 1 year.[5] Mortality associated with a stroke is high, ranging from 20% to 30%.[5] [6][7][8] Patients presenting with VB events are more likely to have a recurrent TIA than patients with carotid events.[5] If the basilar artery is occluated, the death or disability rate is close to 70%.[9] Algorithms using diffusion-weighted imaging(DWI) or CT-based scoring systems have been published for prognostic assessment of early ischemic injury in basilar artery occlusion to distinguish those patients who will most likely benefit from recanalization from those who will not.[10][11][12][13]

Complications

Complications of vertebrobasilar circulatory disorders are stroke and its complications. The complications of stroke include:

  • Respiratory (breathing) failure (which may require use of a machine to help the patient breathe)
  • Lung problems (especially lung infections)
  • Heart attack
  • Dehydration and swallowing problems (sometimes leading to the placement of tubes in the stomach for artificial feeding)
  • Problems with movement or sensation, including paralysis and numbness
  • Formation of clots in the legs

Complications caused by medications or surgery may also occur.

References

  1. ↑ Cartlidge NE, Whisnant JP, Elveback LR (1977) Carotid and vertebral-basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota. Mayo Clin Proc 52 (2):117-20. PMID: 609290
  2. ↑ Heyman A, Wilkinson WE, Hurwitz BJ, Haynes CS, Utley CM, Rosati RA et al. (1984) Risk of ischemic heart disease in patients with TIA. Neurology 34 (5):626-30. PMID: 6538654
  3. ↑ Whisnant JP, Cartlidge NE, Elveback LR (1978) Carotid and vertebral-basilar transient ischemic attacks: effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence--a population study. Ann Neurol 3 (2):107-15. DOI:10.1002/ana.410030204 PMID: 655661
  4. ↑ Marquardt L, Kuker W, Chandratheva A, Geraghty O, Rothwell PM (2009) Incidence and prognosis of > or = 50% symptomatic vertebral or basilar artery stenosis: prospective population-based study. Brain 132 (Pt 4):982-8. DOI:10.1093/brain/awp026 PMID: 19293244
  5. ↑ 5.0 5.1 5.2 Flossmann E, Rothwell PM (2003)Prognosis of vertebrobasilar transient ischaemic attack and minor stroke.Brain 126 (Pt 9):1940-54. DOI:10.1093/brain/awg197 PMID: 12847074
  6. ↑ Jones HR, Millikan CH, Sandok BA (1980) Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction. Stroke 11 (2):173-7. PMID: 7368245
  7. ↑ MCDOWELL FH, POTES J, GROCH S (1961) The natural history of internal carotid and vertebral-basilar artery occlusion. Neurology 11(4)Pt2 ():153-7. PMID: 13773892
  8. ↑ Patrick BK, Ramirez-Lassepas M, Synder BD (1980) Temporal profile of vertebrobasilar territory infarction. Prognostic implications. Stroke 11 (6):643-8. PMID: 7210071
  9. ↑ van der Hoeven EJ, Schonewille WJ, Vos JA, Algra A, Audebert HJ, Berge E et al. (2013) The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial. Trials 14 ():200. DOI:10.1186/1745-6215-14-200 PMID: 23835026
  10. ↑ Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P et al. (2008) Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 39 (9):2485-90. DOI:10.1161/STROKEAHA.107.511162 PMID: 18617663
  11. ↑ Cho TH, Nighoghossian N, Tahon F, Némoz C, Hermier M, Salkine F et al. (2009) Brain stem diffusion-weighted imaging lesion score: a potential marker of outcome in acute basilar artery occlusion. AJNR Am J Neuroradiol 30 (1):194-8. DOI:10.3174/ajnr.A1278 PMID: 18768716
  12. ↑ Renard D, Landragin N, Robinson A, Brunel H, Bonafe A, Heroum C et al. (2008) MRI-based score for acute basilar artery thrombosis. Cerebrovasc Dis 25 (6):511-6. DOI:10.1159/000131668 PMID: 18480603
  13. ↑ Terasawa Y, Kimura K, Iguchi Y, Kobayashi K, Aoki J, Shibazaki K et al. (2010) Could clinical diffusion-mismatch determined using DWI ASPECTS predict neurological improvement after thrombolysis before 3 h after acute stroke? J Neurol Neurosurg Psychiatry 81 (8):864-8. DOI:10.1136/jnnp.2009.190140 PMID: 20562433

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