Vertebrobasilar insufficiency - Revision history

ClaireLewis at 17:07, 3 October 2019

2019-10-03T17:07:24Z

← Older revision		Revision as of 17:07, 3 October 2019
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	==Background==		==Background==
	*Characterized by diminished ~~bloodflow~~ through the vertebral or basilar arteries. The two vertebral arteries originally branch proximally from ~~the subcalvian artery and~~ travel through ~~the~~ vertebrae and distally join to become ~~the~~ basilar artery. Symptoms result from diminished circulation to the posterior brain, brainstem and cerebellum. Head-turning can cause ipsilateral vertebral artery to temporarily occlude~~; if the~~ contralateral vertebral artery is stenotic, ~~this~~ may lead to syncope~~. This is also~~ known as Bow hunter's ~~Syndrome~~<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>		*Characterized by diminished blood flow through the vertebral or basilar arteries
	*Head extension may also provoke symptoms. Neurologic symptoms tend to not present when one vertebral artery remains patent<ref>Ibrahim Alnaami, Muzaffer Siddiqui, and Maher Saqqur, “The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound,” Case Reports in Medicine, vol. 2012, Article ID 894913, 3 pages, 2012. doi:10.1155/2012/894913.</ref>		*The two vertebral arteries originally branch proximally from subclavian, travel through vertebrae, and distally join to become basilar artery
			*Symptoms result from diminished circulation to the posterior brain, brainstem and cerebellum.
	*Symptoms may result secondary to arterial plaques, arterial dissection, compressive lesions, or subclavian steal (see below). Posterior strokes encompass 20-30% of all strokes<ref>Ibrahim Alnaami, Muzaffer Siddiqui, and Maher Saqqur, “The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound,” Case Reports in Medicine, vol. 2012, Article ID 894913, 3 pages, 2012. doi:10.1155/2012/894913.</ref>		*Head-turning can cause ipsilateral vertebral artery to temporarily occlude
	*Cervical ~~ostephytes~~ can also directly compress vertebral arteries and cause VBI symptoms<ref>Tintinalli</ref>.		**If contralateral vertebral artery is stenotic, may lead to [[syncope]] (known as Bow hunter's syndrome<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>)
			*Head extension may also provoke symptoms
			*Neurologic symptoms tend to not present when one vertebral artery remains patent<ref>Ibrahim Alnaami, Muzaffer Siddiqui, and Maher Saqqur, “The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound,” Case Reports in Medicine, vol. 2012, Article ID 894913, 3 pages, 2012. doi:10.1155/2012/894913.</ref>
			Symptoms may result secondary to arterial plaques, arterial dissection, compressive lesions, or subclavian steal (see below). Posterior strokes encompass 20-30% of all strokes<ref>Ibrahim Alnaami, Muzaffer Siddiqui, and Maher Saqqur, “The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound,” Case Reports in Medicine, vol. 2012, Article ID 894913, 3 pages, 2012. doi:10.1155/2012/894913.</ref>
			*Cervical osteophytes can also directly compress vertebral arteries and cause VBI symptoms<ref>Tintinalli</ref>.

	===Bow hunter's syndrome (Rotational vertebral artery compression)===		===Bow hunter's syndrome (Rotational vertebral artery compression)===
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	===[[Subclavian steal]] phenomenon===		===[[Subclavian steal]] phenomenon===
	~~A stenotic~~ lesion in the subclavian, located proximal to the vertebral artery~~, results in reversing the~~ flow of blood in the vertebral artery when superimposed with increased arm activity(4).		*Stenotic lesion in the subclavian, located proximal to the vertebral artery--> reversed flow of blood in the vertebral artery when superimposed with increased arm activity(4).

	==Clinical Features==		==Clinical Features==
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	===[[EBQ: HINTS Exam\|HINTS Exam]]===		===[[EBQ: HINTS Exam\|HINTS Exam]]===
	Proposed as method of distinguishing peripheral cause from cerebellar/brain stem CVA in the Emergency Department population <ref>http://ec.libsyn.com/p/a/d/d/add761f2a2847ea5/hints-exam.pdf?d13a76d516d9dec20c3d276ce028ed5089ab1ce3dae902ea1d01c0873ed8cc5fe910&c_id=2502227</ref><ref>http://www.ncbi.nlm.nih.gov/pubmed/18541870</ref><ref>http://hwcdn.libsyn.com/p/1/c/d/1cd6b38a89c178a1/diff-of-vertigo.pdf?c_id=2502226&expiration=1380995436&hwt=0a8bc67ea910e018a1543ebea192f668</ref>		*Proposed as method of distinguishing peripheral cause from cerebellar/brain stem CVA in the Emergency Department population <ref>http://ec.libsyn.com/p/a/d/d/add761f2a2847ea5/hints-exam.pdf?d13a76d516d9dec20c3d276ce028ed5089ab1ce3dae902ea1d01c0873ed8cc5fe910&c_id=2502227</ref><ref>http://www.ncbi.nlm.nih.gov/pubmed/18541870</ref><ref>http://hwcdn.libsyn.com/p/1/c/d/1cd6b38a89c178a1/diff-of-vertigo.pdf?c_id=2502226&expiration=1380995436&hwt=0a8bc67ea910e018a1543ebea192f668</ref>

	{{HINTS Exam Procedure}}		{{HINTS Exam Procedure}}
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	===Medical management===		===Medical management===
	#Lower cholesterol		*Lower cholesterol
	#Control [[hypertension]]		*Control [[hypertension]]
	#Smoking cessation		*Smoking cessation
	#[[Antiplatelet]]s		*[[Antiplatelet]]s

	===Surgical management===		===Surgical management===

	#Endarterectomy		*Endarterectomy
	#Bypass grafting		*Bypass grafting
	#Stenting		*Stenting

	==Disposition==		==Disposition==

ClaireLewis at 22:27, 2 October 2019

2019-10-02T22:27:30Z

← Older revision		Revision as of 22:27, 2 October 2019
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	*[[Numbness]]/tingling		*[[Numbness]]/tingling
	*[[Vertigo]]/dizziness		*[[Vertigo]]/dizziness
	*Changes in vision		*[[visual disturbances\|Changes in vision]]
	*[[Nausea/vomiting]]		*[[Nausea/vomiting]]
	*[[Weakness]]		*[[Weakness]]
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	===Medical management===		===Medical management===
	#Lower cholesterol		#Lower cholesterol
	#Control hypertension		#Control [[hypertension]]
	#Smoking cessation		#Smoking cessation
	#~~Antiplatelets~~		#[[Antiplatelet]]s

	===Surgical management===		===Surgical management===

Rossdonaldson1: /* Subclavian Steal phenomenon */

2016-09-24T07:17:56Z

Subclavian Steal phenomenon

← Older revision		Revision as of 07:17, 24 September 2016
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	*Head turning causes temporary occlusion of the ipsilateral vertebral artery. VBI results if the contralateral vertebral artery has a fixed occlusion<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>. Improvement of symptoms in neutral position is considered pathognomonic<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>		*Head turning causes temporary occlusion of the ipsilateral vertebral artery. VBI results if the contralateral vertebral artery has a fixed occlusion<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>. Improvement of symptoms in neutral position is considered pathognomonic<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>

	===[[Subclavian ~~Steal~~]] phenomenon===		===[[Subclavian steal]] phenomenon===
	A stenotic lesion in the subclavian, located proximal to the vertebral artery, results in reversing the flow of blood in the vertebral artery when superimposed with increased arm activity(4).		A stenotic lesion in the subclavian, located proximal to the vertebral artery, results in reversing the flow of blood in the vertebral artery when superimposed with increased arm activity(4).

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-26T15:43:26Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 15:43, 26 July 2016
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	{{Vertigo DDX}}		{{Vertigo DDX}}

	==~~Diagnosis~~==		==Evaluation==
	{{Vertigo workup}}		{{Vertigo workup}}

Neil.m.young: Text replacement - " w/ " to " with "

2016-07-13T13:54:59Z

Text replacement - " w/ " to " with "

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	{{HINTS Exam Primary Outcome}}		{{HINTS Exam Primary Outcome}}

	*''If any of the above 3 tests are consistent w/ CVA obtain full work-up (including MRI)''		*''If any of the above 3 tests are consistent with CVA obtain full work-up (including MRI)''

	==Management==		==Management==

Neil.m.young: Text replacement - "== " to "=="

2016-07-10T12:45:25Z

Text replacement - "== " to "=="

← Older revision		Revision as of 12:45, 10 July 2016
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	*Cervical ostephytes can also directly compress vertebral arteries and cause VBI symptoms<ref>Tintinalli</ref>.		*Cervical ostephytes can also directly compress vertebral arteries and cause VBI symptoms<ref>Tintinalli</ref>.

	=== Bow hunter's syndrome (Rotational vertebral artery compression)===		===Bow hunter's syndrome (Rotational vertebral artery compression)===
	*Head turning causes temporary occlusion of the ipsilateral vertebral artery. VBI results if the contralateral vertebral artery has a fixed occlusion<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>. Improvement of symptoms in neutral position is considered pathognomonic<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>		*Head turning causes temporary occlusion of the ipsilateral vertebral artery. VBI results if the contralateral vertebral artery has a fixed occlusion<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>. Improvement of symptoms in neutral position is considered pathognomonic<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>

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	==Clinical Features==		==Clinical Features==
	=== Symptoms===		===Symptoms===
	*[[Numbness]]/tingling		*[[Numbness]]/tingling
	*[[Vertigo]]/dizziness		*[[Vertigo]]/dizziness
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	#Antiplatelets		#Antiplatelets

	=== Surgical management===		===Surgical management===

	#Endarterectomy		#Endarterectomy

Neil.m.young: Text replacement - "# " to "#"

2016-07-10T04:11:42Z

Text replacement - "# " to "#"

← Older revision		Revision as of 04:11, 10 July 2016
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	==Background==		==Background==
	*Characterized by diminished bloodflow through the vertebral or basilar arteries. The two vertebral arteries originally branch proximally from the subcalvian artery and travel through the vertebrae and distally join to become the basilar artery. Symptoms result from diminished circulation to the posterior brain, brainstem and cerebellum. Head-turning can cause ipsilateral vertebral artery to temporarily occlude; if the contralateral vertebral artery is stenotic, this may lead to syncope. This is also known as Bow hunter's Syndrome<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>		*Characterized by diminished bloodflow through the vertebral or basilar arteries. The two vertebral arteries originally branch proximally from the subcalvian artery and travel through the vertebrae and distally join to become the basilar artery. Symptoms result from diminished circulation to the posterior brain, brainstem and cerebellum. Head-turning can cause ipsilateral vertebral artery to temporarily occlude; if the contralateral vertebral artery is stenotic, this may lead to syncope. This is also known as Bow hunter's Syndrome<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>
	*Head extension may also provoke symptoms. Neurologic symptoms tend to not present when one vertebral artery remains patent<ref>Ibrahim Alnaami, Muzaffer Siddiqui, and Maher Saqqur, “The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound,” Case Reports in Medicine, vol. 2012, Article ID 894913, 3 pages, 2012. doi:10.1155/2012/894913.</ref>		*Head extension may also provoke symptoms. Neurologic symptoms tend to not present when one vertebral artery remains patent<ref>Ibrahim Alnaami, Muzaffer Siddiqui, and Maher Saqqur, “The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound,” Case Reports in Medicine, vol. 2012, Article ID 894913, 3 pages, 2012. doi:10.1155/2012/894913.</ref>

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	=== Bow hunter's syndrome (Rotational vertebral artery compression)===		=== Bow hunter's syndrome (Rotational vertebral artery compression)===
	*Head turning causes temporary occlusion of the ipsilateral vertebral artery. VBI results if the contralateral vertebral artery has a fixed occlusion<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>. Improvement of symptoms in neutral position is considered pathognomonic<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>		*Head turning causes temporary occlusion of the ipsilateral vertebral artery. VBI results if the contralateral vertebral artery has a fixed occlusion<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>. Improvement of symptoms in neutral position is considered pathognomonic<ref>#Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>

	===[[Subclavian Steal]] phenomenon===		===[[Subclavian Steal]] phenomenon===

Neil.m.young: Text replacement - " ==" to "=="

2016-07-09T22:16:17Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 22:16, 9 July 2016
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	#Antiplatelets		#Antiplatelets

	=== Surgical management ===		=== Surgical management===

	#Endarterectomy		#Endarterectomy

Rossdonaldson1: /* References */

2016-05-11T13:50:37Z

References

← Older revision		Revision as of 13:50, 11 May 2016
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	==References==		==References==
	<references/>		<references/>

			[[Category:Neurology]]

Rossdonaldson1 at 13:43, 11 May 2016

2016-05-11T13:43:43Z

← Older revision		Revision as of 13:43, 11 May 2016
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	==Background==		==Background==
	~~Vertebrobasilar insufficiency (VBI) is characterized~~ by diminished bloodflow through the vertebral or basilar arteries. The two vertebral arteries originally branch proximally from the subcalvian artery and travel through the vertebrae and distally join to become the basilar artery. Symptoms result from diminished circulation to the posterior brain, brainstem and cerebellum. Head-turning can cause ipsilateral vertebral artery to temporarily occlude; if the contralateral vertebral artery is stenotic, this may lead to syncope. This is also known as Bow hunter's Syndrome<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>		*Characterized by diminished bloodflow through the vertebral or basilar arteries. The two vertebral arteries originally branch proximally from the subcalvian artery and travel through the vertebrae and distally join to become the basilar artery. Symptoms result from diminished circulation to the posterior brain, brainstem and cerebellum. Head-turning can cause ipsilateral vertebral artery to temporarily occlude; if the contralateral vertebral artery is stenotic, this may lead to syncope. This is also known as Bow hunter's Syndrome<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>
	*Head extension may also provoke symptoms. Neurologic symptoms tend to not present when one vertebral artery remains patent<ref>Ibrahim Alnaami, Muzaffer Siddiqui, and Maher Saqqur, “The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound,” Case Reports in Medicine, vol. 2012, Article ID 894913, 3 pages, 2012. doi:10.1155/2012/894913.</ref>		*Head extension may also provoke symptoms. Neurologic symptoms tend to not present when one vertebral artery remains patent<ref>Ibrahim Alnaami, Muzaffer Siddiqui, and Maher Saqqur, “The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound,” Case Reports in Medicine, vol. 2012, Article ID 894913, 3 pages, 2012. doi:10.1155/2012/894913.</ref>

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	*Head turning causes temporary occlusion of the ipsilateral vertebral artery. VBI results if the contralateral vertebral artery has a fixed occlusion<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>. Improvement of symptoms in neutral position is considered pathognomonic<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>		*Head turning causes temporary occlusion of the ipsilateral vertebral artery. VBI results if the contralateral vertebral artery has a fixed occlusion<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>. Improvement of symptoms in neutral position is considered pathognomonic<ref># Go G, Hwang S-H, Park IS, Park H. Rotational Vertebral Artery Compression : Bow Hunter’s Syndrome. Journal of Korean Neurosurgical Society. 2013;54(3):243-245. doi:10.3340/jkns.2013.54.3.243.</ref>


	===[[Subclavian Steal]] phenomenon===		===[[Subclavian Steal]] phenomenon===
	A stenotic lesion in the subclavian, located proximal to the vertebral artery, results in reversing the flow of blood in the vertebral artery when superimposed with increased arm activity(4).		A stenotic lesion in the subclavian, located proximal to the vertebral artery, results in reversing the flow of blood in the vertebral artery when superimposed with increased arm activity(4).