Vertebrobasilar insufficiency natural history, complications and prognosis
| 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 depend on the severity of symptoms the patients present. For patients who experience vertebrobasilar transient ischemic attack, disease identified in the vertebral arteries portends a 30%to 35%risk for stroke during a 5-year period.[1][2][3] Medical refractory disease of the vertebrobasilar system carries a 5% to 11% risk of stroke or death at 1 year.[4] Mortality associated with a posterior circulation stroke is high, ranging from 20% to 30%.[4] [5][6][7] Recent studies have shown that they are associated with a high risk of early recurrent stroke.
Complications
One of the complications is vertebral artery dissection. It is the development of dissection (a flap-like tear) in the vertebral artery. It is commonly associated with physical trauma but may also develop spontaneously. It is a major cause of stroke in young people.
References
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 4.0 4.1 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
- ↑ Jones HR, Millikan CH, Sandok BA (1980) Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction. Stroke 11 (2):173-7. PMID: 7368245
- ↑ 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
- ↑ Patrick BK, Ramirez-Lassepas M, Synder BD (1980) Temporal profile of vertebrobasilar territory infarction. Prognostic implications. Stroke 11 (6):643-8. PMID: 7210071