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    Vertebrobasilar circulatory disorders

    Vertebrobasilar insufficiency; Posterior circulation ischemia; Beauty parlor syndrome; TIA - vertebrobasilar insufficiency; Dizziness - vertebrobasilar insufficiency; Vertigo - vertebrobasilar insufficiency

    Vertebrobasilar circulatory disorders are conditions in which the blood supply to the back of the brain is disrupted.

    Causes

    In the neck, two vertebral arteries join to form the basilar artery, which enters the skull. These are the main blood vessels that provide blood flow to the back of the brain.

    The areas in the back of the brain that receive blood from these arteries are needed to keep a person alive. These areas regulate breathing, heart rate, swallowing, vision, movement, and posture or balance. All of the nervous system signals that connect the brain to the rest of the body pass through the back of the brain.

    Many different conditions may reduce or stop blood flow in the back part of the brain. The most common risk factors are smoking, high blood pressure, diabetes, increased age, and a high cholesterol level. These are similar to the risk factors for any stroke.

    Other causes include:

    • Tear in the wall of an artery
    • Blood clots in the heart that travel to the vertebral or basilar arteries and cause a stroke
    • Blood vessel inflammation (vasculitis)
    • Connective tissue diseases
    • Problems in the spinal bones of the neck
    • Outside pressure on the vertebral or basilar arteries, such as from a salon sink (nicknamed beauty parlor syndrome)

    Symptoms

    Common symptoms may include:

    • Difficulty pronouncing words, slurred speech
    • Difficulty swallowing
    • Double vision or vision loss
    • Numbness or tingling, most often on the face or scalp
    • Sudden falls (drop attacks)
    • Vertigo (sensation of things spinning around)
    • Memory loss

    Other symptoms may include:

    • Bladder or bowel control problems
    • Difficulty walking (unsteady gait)
    • Headache, neck ache
    • Hearing loss
    • Muscle weakness
    • Nausea and vomiting
    • Pain in one or more parts of the body, which gets worse with touch and cold temperatures
    • Poor coordination
    • Sleepiness or sleep from which the person cannot be awakened
    • Sudden, uncoordinated movements
    • Sweating on the face, arms, or legs

    Exams and Tests

    You may have the following tests, depending on the cause:

    Treatment

    Vertebral or basilar symptoms that start suddenly are a medical emergency that need to be treated right away. Treatment is similar to that for stroke. Depending on how long you have had symptoms among others, a medicine may be infused to break open any blood clots. A catheter may be inserted into a blood vessel to remove a clot. Some people receive both treatments.

    To prevent the condition, your health care provider may recommend:

    • Taking blood-thinning medicines, such as aspirin, novel oral anticoagulants (such as apixaban, rivaroxaban, or others) or clopidogrel (Plavix) to lower the risk for stroke
    • Changing your diet
    • Medicine to lower cholesterol and better regulate blood pressure
    • Exercising
    • Losing weight
    • Stopping smoking

    Invasive procedures or surgery of narrowed arteries for stroke prevention in this part of the brain are not well studied or proven.

    Outlook (Prognosis)

    The outlook depends on:

    • The amount of brain damage
    • What body functions have been affected
    • How quickly you get treatment
    • How quickly you recover

    Each person has a different recovery time and need for long-term care. Problems with moving, thinking, and talking often improve in the first weeks or months. Some people will keep improving for months or years.

    Possible Complications

    Complications of vertebrobasilar circulatory disorders are the same as for a stroke. These include:

    • Breathing (respiratory) failure (which may require the use of a machine to help the person breathe)
    • Lung problems (especially lung infections)
    • Heart attack
    • Lack of fluids in the body (dehydration) and swallowing problems (sometimes requiring tube feeding)
    • Problems with movement or sensation, including paralysis and numbness
    • Formation of blood clots in the legs
    • Vision loss

    Complications caused by medicines or surgery may also occur.

    When to Contact a Medical Professional

    Call 911 or the local emergency number, or get to the emergency room if you have any symptoms of a vertebral or basilar circulatory disorder.

    Open References

    References

    Crane BT, Kaylie DM. Central vestibular disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 168.

    Jovin TG, Li C, Wu L, et al. Trial of thrombectomy 6 to 24 Hours after stroke due to basilar-artery occlusion. N Engl J Med. 2022;387(15):1373-1384. PMID: 36239645 pubmed.ncbi.nlm.nih.gov/36239645/.

    Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467. PMID: 34024117 pubmed.ncbi.nlm.nih.gov/34024117/.

    Kim JS, Caplan LR. Vertebrobasilar disease. In: Grotta JC, Albers GW, Broderick JP, et al, eds. Stroke: Pathophysiology, Diagnosis, and Management. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 26.

      • Arteries of the brain

        Arteries of the brain - illustration

        The internal carotid arteries and the vertebral arteries supply blood to the brain.

        Arteries of the brain

        illustration

        • Arteries of the brain

          Arteries of the brain - illustration

          The internal carotid arteries and the vertebral arteries supply blood to the brain.

          Arteries of the brain

          illustration

        Review Date: 8/19/2024

        Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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