07.04.2019

Narrowing of the intracranial vertebral arteries. Symptoms and diagnosis

Diseases of the cervical spine have now become widespread not only among elderly and middle-aged people, but also among young people. At the same time, the number of vertebrogenic vascular disorders of the brain, which have become an urgent problem of modern medicine, is growing. AND important role V similar situation plays stenosis vertebral artery.

General information

The blood supply to the brain comes from two main basins: carotid and vertebral (carotid and vertebral arteries, respectively). The latter covers a quarter of the total need for oxygen and nutrients - it vascularizes the following structures:

Brain stem.
Cerebellum.
Occipital lobes.
Extensive part temporal lobes.
Posterior part of the hypothalamus.
Spinal cord (segments C1–Th3).
Inner ear.

Damage to the vertebral artery in diseases of the cervical spine is determined by its anatomical and topographical features. The vessel, together with the nerve of the same name, passes through the canal, which is formed by openings in the transverse processes of the vertebrae. The latter is not static, since it changes according to movements in the neck. In the vertebral artery itself, according to its location, several segments are distinguished:

1 – from subclavian artery before entering the canal.
2 – in the canal at the level of C2–C6 vertebrae.
3 – from the exit from the canal to the entrance to the cranial cavity.
4 – in the cranial cavity (intracranial).

In the canal, the artery borders posteriorly with the uncovertebral joints, and laterally with the superior articular processes. After leaving it, the vessel bends twice: in the frontal and sagittal planes. It is in these places that disruption of blood flow through the vertebral artery often occurs.

The topographic and anatomical features of the vertebral artery make it vulnerable to the adverse effects of a number of external and internal factors that contribute to impaired blood flow through the vessel.

Causes

The narrowing of the lumen of any vessel is provoked by several reasons. Compression of the wall from the outside by pathological formations (bone fragments, tumor, hematoma, etc.), internal blockage by an atherosclerotic plaque, thrombus, embolus, and, finally, spasm of the muscularis propria (most often reflex) is possible. In relation to the vertebral artery, it is customary to distinguish two main groups of factors:

Vertebrogenic.
Nonvertebrogenic.

The former cause external compression of the vascular wall and the adjacent nerve due to pathological changes in the cervical spine. In this case, the compressive elements are:

Bone growths (osteophytes).
Disc herniation.
Osteoarthrosis (of the facet joints).
Instability of spinal segments.

Structural disorders in the spine affect not only the artery itself, but also the nerve fibers entwining it, leading to a reflex spasm. The factors of external compression can easily include the muscles of the neck - hypertrophied or spasmed (anterior scalene, inferior oblique) - which often accompanies pathology of the spinal column.

It should be noted that even under physiological conditions, the vertebral artery is subject to changes in its lumen when moving the head, but normally the limitation of blood flow is well compensated. And if, along with external compression, there are changes in the vessel itself, then the situation is aggravated many times over, manifesting itself as clear hemodynamic disturbances in the vertebrobasilar region. Factors unrelated to the condition of the spine include:

Internal occlusion with thrombosis, atherosclerosis, arteritis, embolism.
Vascular deformations: pathological tortuosity, additional loops, kinks, course anomalies.
External compression by scars, adhesions, hematomas and other space-occupying formations.

Thus, the causes of stenosis cover a wide range of pathologies - both local and systemic. Therefore, in the practice of a neurologist, vertebrologist and traumatologist, great importance is given to the differential diagnosis of vertebral artery syndrome.

Narrowing of the vertebral artery in most cases is caused by pathology of the cervical spine, but there are also non-vertebral causes of stenosis.

Symptoms

Based on the functional load on the vertebral artery, it is easy to predict what manifestations of stenosis may occur. Disruption of blood flow through the vessel due to the failure of compensatory mechanisms provokes hypoxic changes on the part of those structures that feed from the vertebral part of the brain basin. Of course, everything depends on the severity of pathological changes, but it should be mentioned that hemodynamically significant stenosis corresponds to blocking of the vascular lumen by 50% or more. Accordingly, the stronger the external compression or internal occlusion, the more significant the clinical picture.

The complex of neurological disorders that occur with stenosis is combined into the concept. In the early stages, it has a functional nature, that is, it occurs only at the moment of provoking movements - a sharp tilt or turn of the head - as well as in the case of a prolonged forced position. The following symptoms occur:

Headache.
Cochleovestibular disorders.
Visual impairment.
Autonomic dysfunction.

Vertebrogenic pains have a burning, pulsating or aching character; they intensify in paroxysms, spreading from the back of the head to the parietotemporal and frontal zones. Cochleovestibular disorders include dizziness, unsteadiness and unsteadiness of gait. Visual impairment is manifested by darkening, flashing “spots” or “zigzags” before the eyes (photopsia). This may be accompanied by autonomic reactions such as a feeling of heat, increased sweating, and increased heart rate.

With persistent and severe stenosis, acute and transient disturbances of cerebral circulation are observed, leading to the appearance of foci of ischemia. Transient attacks do not last more than 48 hours and are characterized by:

Dizziness.
Ataxia (coordination disorders).
Nausea, vomiting.
Speech disorders.

In addition, sensory disturbances in the form of numbness and crawling “goosebumps” around the mouth, in the upper or lower extremities are possible. As a rule, this symptom is unilateral, appearing with left or right vertebral artery syndrome.

If the stenosis is of vertebrogenic origin, then transient ischemic disorders can be detected during movements in the neck. Thus, patients often experience sudden falls while maintaining consciousness (drop attacks) or fainting (syncope). After such an attack, general weakness, lethargy, headache, ringing in the ears, flickering “spots” in the eyes, sweating.

With vertebral artery syndrome, a combination of various clinical variants of hypoxic-ischemic disorders in the structures of the brain is observed.

Additional diagnostics

Vertebral artery syndrome requires careful differentiation from other conditions that have similar symptoms. The polymorphism of the clinical picture makes it difficult to form a preliminary conclusion - there is a risk of both under- and over-diagnosis. But along with this, the doctor must be guided by the results of additional studies that reveal changes in the spine, the vessel itself or the surrounding soft tissues. These include:

with functional load.
Tomography (magnetic resonance, computer).
Ultrasound with Dopplerography.

Only if all the clinical and instrumental signs are present can we confidently say about vertebral artery stenosis and count on its adequate treatment.

Treatment

To effectively treat vertebral artery syndrome, you need to know its cause. Based on the variety of pathological processes and mechanisms contributing to stenosis, therapy is characterized by a wide range of effects using various methods and ways. But each case is, of course, individual, and the approach to the patient should be carried out through the prism of all the characteristics of the body, and not just taking into account the degree of narrowing.

Medication

Great importance in the treatment of vertebral artery syndrome is given medications. The list of drugs used in such patients is quite impressive, since it is necessary to act not only on clinical symptoms or altered structures of the spine, but also on the vessel wall, blood flow in it and brain tissue susceptible to hypoxia. Therefore, the following medications are used:

Non-steroidal anti-inflammatory drugs (Xefocam, Larfix,).
Muscle relaxants (Mydocalm).
Decongestants (L-lysine escinate).
Vascular (Latren, Actovegin).
Antispasmodics (No-spa).
Metabolic (Mexidol, Cytoflavin).
Neuroprotectors (Cortexin).
Venotonics (Detralex, Troxevasin).
Chondroprotectors (Dona, Artra).
Vitamins (Milgamma,).

Expressed pain syndrome can be stopped using paravertebral blockades with Novocaine and glucocorticoids (Diprospan). Local forms of medications (ointment, gel, cream) are also of certain importance.

Drug treatment of vertebral artery syndrome is carried out in strict accordance with the recommendations of a specialist. You cannot deviate from medical prescriptions, because the final effect depends on this.

Non-drug

Among the conservative measures used in patients with vertebral artery stenosis, non-drug agents are widely used. They affect factors of external compression of the vessel, surrounding tissues, improve cerebral blood flow and have a general tonic effect. They use these healing methods:

Physiotherapy.
Gymnastics.
Massage.
Manual therapy.

It must be remembered that active influence on the spine should be carried out only after the elimination of acute phenomena, since otherwise the symptoms of the pathology will only worsen. This applies to physical therapy with post-isometric exercises and manual therapy. You should wait until the full effect of the use of medications appears.

Surgical

To completely eliminate the basis of vertebrogenic syndrome, in many cases it is necessary to seek help from surgeons. Surgically, space-occupying formations protruding into the spinal canal (osteophytes, hernias) are eliminated, thus decompressing the artery. Sometimes it is necessary to perform a resection of the sympathetic nerve plexus, and in case of internal blockage, vascular techniques are used to remove blood clots and plaques.

The effectiveness of treatment largely depends on timely implementation diagnostic measures. Regardless of the causes of stenosis - spinal-related or non-vertebral - the appearance of clinical symptoms should be a reason to consult a doctor. A specialist will determine their origin and prescribe appropriate therapy.

The blood supply to the brain is accompanied by two channels - the carotid and vertebrogenic arteries. If one or two of these channels is disrupted, a person begins to experience migraines, hearing impairment, vision problems, and other symptoms. This syndrome disrupts blood flow to the brain and causes serious consequences, so it must be treated at the very beginning, without waiting for complications.

Vertebrogenic vertebral artery syndrome is a severe narrowing of the vessel and compressive pressure on the surrounding nervous system. If a person begins to develop bone pathology, then this artery comes under attack.

In the brain, the carotid and vertebrogenic arteries merge; they feed all the main structures of the brain. When these arteries are damaged, the functioning of all the structures to which they deliver blood is disrupted.

The main part of this flow is located in the mobile canal, consisting of the vertebrae and their processes. Frank's nerve is located in the same canal and completely encircles the vertebrogenic artery.

Symptoms of the disease

The disease begins with severe headaches, which is also called cervical migraine. This pain has the following characteristics:

spread from neck to temples;
character changes with every head movement;
pain occurs when palpating the vertebrae;
manifests itself in a different character - pulsating, shooting, bursting;
different duration of pain attacks;
pain is accompanied by other symptoms.

Dizziness

Occurs most often in morning hours, especially if the patient sleeps on high pillows. Sometimes occurs during the day. Duration from a minute to several hours. Eliminated by wearing a Shants collar.

Noise in ears

Most patients experience this exact symptom. The noise comes from both sides at once. It can appear at different times and always lasts differently. The severity may vary and depend on the condition of the inner ear. As you turn your head, the intensity may change.

If the noise always occurs on one side, then this side is considered affected.

Numbness

In some cases, numbness of the face occurs on one side. Common affected areas are around the mouth and neck, as well as one of the upper limbs.

Fainting

A person loses consciousness if stenosis of the arteries occurs. Occurs if there has been overbending of the head for a long time. Before loss of consciousness, dizziness, numbness of some parts of the face, impaired speech coherence and blindness in one eye begin.

Nausea

The appearance of nausea, especially if it is accompanied by vomiting, is considered a harbinger of the disease. But this symptom is not associated with increased pressure inside the skull.

Depression

The appearance of depression does not occur immediately; it occurs not only when the blood supply is disrupted, but also for moral reasons, most often when the patient begins to get tired of all the symptoms accompanying the disease.

Signs of the syndrome in cervical osteochondrosis

When degenerative processes begin to occur, displacement of the vertebrae occurs in the spine, which crushes the lumen of the artery and causes disease. As a result, all the symptoms of the disease begin to appear, including blurred vision, arm pain and palpitations.

At the first symptoms, it is necessary to undergo a diagnosis and determine the nature and extent of the disease. A neuropathologist deals with this disease.

Reasons for violations

As the disease develops, irreversible damage to the brain tissue may occur because it lacks nutrition. Violations can occur on both sides or on one. And depending on the location of the symptoms, right and left syndromes are distinguished.

There are two causes of the disease - vertebrogenic, that is, a pathology of the spine, and non-vertebrogenic, that is, not associated with disorders in the spine. Vertebrogenic syndrome is caused by disorders in the spinal column, in this case, displacement of the vertebrae, since when displaced, the arteries are compressed, and the syndrome occurs. But the non-vertebrogenic cause includes arterial hypoplasia and atherosclerosis. With such disorders, blood permeability deteriorates significantly, and this has a negative effect on the head.

With severe degrees of the disease, the outcome can be very poor, so it is necessary to start treatment in a timely manner.

Why is the syndrome dangerous?

This disease, if not provided timely treatment, can carry serious complications that can become hazardous to health.

The first signs of poor circulation in a small or large area of the brain in the head are slurred speech and ablation of a leg or arm. They begin to appear rarely, but become more frequent as the disease progresses. If you don't pay attention to them, it can lead to a stroke.

The nature of the disorder in the case of a stroke is ischemic in nature, the cause is compression of the artery from the outside, as a result, for the normal functioning of the brain there is not enough blood supplied and a disorder occurs.

Physiological compensation of cerebral circulatory disorders also occurs by increasing perfusion pressure. First of all, there is an increase in blood pressure, in this case there is a negative effect on the brain, heart and visual organs.

Signs of vertebrogenic influence on the vertebral arteries and their complications do not always cause a stroke, but disability occurs very often because of them.

Diagnosis and treatment of vertebral artery syndrome

When the first symptoms occur, you should consult a doctor, this could be a neurologist or therapist. The doctor, after listening to the patient and clarifying all the symptoms, conducts an external examination and makes a rough diagnosis, after which the patient must undergo a full examination.

The disease is determined using Doppler ultrasound; this procedure may resemble a regular ultrasound. The examination allows you to determine the patency, speed and nature of blood movement through the arteries. This examination is the main one at the time of making an accurate diagnosis.

As an additional study, the patient undergoes an MRI of the brain. It helps to identify all the possible reasons that caused the trophic disorder. That is, the examination determines the state of the blood supply to the brain, areas of ischemia, and possible cysts.

To identify disorders in the bone structure that may cause the disease, the patient undergoes an X-ray of the cervical spine.

Vertebral arteries, when a violation occurs in them, require immediate treatment. In this case, only complex methods are used, which include eliminating the influence of compression, reducing the inflammatory process and increasing the activity of all processes in the arteries.

Drug treatment

Among medical supplies For treatment, NSAIDs are primarily used, that is, nonsteroidal anti-inflammatory drugs, muscle relaxants and painkillers.

In this case, NSAIDs are used intravenously, as the effectiveness of the drugs is enhanced. All groups relieve pain, reduce temperature and eliminate inflammation. They significantly slow down the transition of neutrophils to inflammatory foci and reduce platelet adhesion.

The use of muscle relaxants helps reduce hypertension and reduce pain, and they also reduce the patient’s period of disability. The effect of such treatment is manifested by potentiation of the spinal cord system, which causes the excitatory systems to stop and the spinal reflex to be suppressed.

Taking analgesics for this disease significantly eliminates muscle spasm.

Surgical methods of treatment

Treatment with surgery is prescribed only if other treatment methods do not help and if the artery has narrowed by more than 2 mm.

In modern neurosurgical clinics, such operations are currently performed using endoscopic techniques. The incision on the skin does not exceed 2 cm. With such an operation there is no danger to other vital organs.

The operation can be performed by excision of the site of narrowing and plastic surgery on the vessel, insertion of a special balloon filled with a stent, and if a tumor or hernia on the intervertebral disc was detected during diagnosis, then the compressive effect on the artery is removed.

The surgical method helps 90% of patients. After the operation, all symptoms disappear and the person returns to the normal rhythm of life.

Traditional methods

Traditional medicine is used only in combination with drug therapy; it is used only to increase the effectiveness of drugs. But this method is not able to completely replace traditional treatment.

Garlic is used to thin the blood. To do this, it is ground in a meat grinder and the resulting mass is placed in a jar. Let it brew for 3 days. The contents must be strained and equal proportions of honey and lemon juice added. Take 1 teaspoon once a day before bedtime.

This disease carries many dangers, so it is undesirable to start it. At the first symptoms, you should consult a doctor and begin appropriate treatment. Self-treatment in these cases is not allowed, otherwise it can lead to serious problems.

Stenosis (narrowing) of the vertebral artery (left or right) leads to severe brain symptoms: severe pain in the left and right half of the head, loss of consciousness, convulsions. With right stenosis, the pain syndrome is localized on the right, with left stenosis - on the opposite side.

At early diagnosis vertebral compression is prevented by proper treatment irreversible changes brain tissue. Through this vessel blood flows to the brain tissue. About 20% of the structures are fed by blood supply from the vertebral arteries on the right and left, passing through the openings of the transverse processes of the vertebrae of the neck.

MRI of the cervical spine in a patient with vertebrobasilar insufficiency

X-ray with narrowing of the lumen of the vertebral artery: right or left

Traditional radiography with narrowing of the lumen of the vertebral arteries (right or left) does not show pathological manifestations. Neurologists send patients with certain clinical symptoms:

1. Dyspeptic phenomena(vomiting, nausea);
2. Pain syndrome of the cervical-occipital part;
3. Peripheral tenderness (helmet removal symptom);
4. Strengthening the clinic when sleeping on a pillow;
5. Shooting, throbbing pain when externally applied to the head (touch, wind).

In patients with vertebral artery stenosis, neurologists often observe vestibular syndrome, in which staggering, instability, and severe attacks of dizziness are observed.

Even with an uncomplicated course, a short-term loss of consciousness is possible during sharp turn head, vibration, pressure on the neck. A person with such clinical symptoms should not drive a car.

Noise, nausea, hearing loss affect everyday life as a manifestation of a number of secondary pathology from the inner ear, brain.

Traditional radiography of the cervical spine visualizes narrowing of the intervertebral discs during a degenerative-dystrophic process, prolapse, or hernia.

The task of an x-ray in the presence of a drop attack (sudden fall) is to establish the likelihood of a violation of the blood supply in the vertebrobasilar system, to identify possible displacement of the vertebrae, instability, and scoliosis. For these purposes, functional photographs are taken with maximum flexion and extension of the neck. X-rays help assess the degree of cervical flexion and exclude or confirm vertebral instability.

MR angiography of the vertebral arteries with stenosis. When prescribing radiography, a radiologist identifies the proliferation of marginal osteophytes in the area of the semilunar joints. The changes are clearly visualized in the direct image. Osteophytes are localized along the upper edge of the contours of the anterior part of the vertebral bodies.

Lateral radiographs of the cervical spine examine the condition of the cervical vertebrae, intervertebral spaces, and hyperlordosis (excessive convexity of the natural curvature).

With any of these disorders, decreased vision, eye fatigue, and pathology of the visual analyzer are observed. With late therapy, it is impossible to prevent the irreversible development of visual impairment using either conservative or surgical methods. X-rays of the cervical spine do not show shadows of the vessel. To study the state of blood supply, contrast angiography, magnetic resonance imaging, and Doppler sonography are required.

Methods for radiological diagnosis of stenosis of the right or left vertebral artery will be discussed below.

Why does narrowing of the vertebral artery develop?

Impaired blood supply to the brain depends on the degree of compression of the vertebral artery. The narrowing is caused by atherosclerosis, nerve spasm, external compression of the vertebrae, tumor, thromboembolism.

The cause of impaired blood supply to the vertebrobasilar area may be tortuosity of one or both vertebral arteries. To treat the pathology, stenting and balloon angioplasty are used.

The procedures are performed under local anesthesia. The stent is installed through a puncture in the femoral area. The introduction of an endoprosthesis is necessary to maintain the physiological lumen of the vessel. Until a few years ago, stenting was performed under X-ray control. A scopic cover was used to visualize the insertion of the balloon stent. The movement of the balloon from the femoral to the vertebral artery is clearly visible on the X-ray television screen. The procedure led to radiation exposure of the patient, so at the present stage the intervention is monitored under the guise of ultrasound.

Narrowing of the left vertebral artery: symptoms

Narrowing of the left vertebral artery can be suspected if the following symptoms are present:

1. Headache syndrome is characterized by dull, burning pain with localization in the parietal occipital region. The symptom intensifies with severe physical activity. The probable location of pain is the superciliary, temporal, parietal areas;
2. Symptoms from the gastrointestinal tract. Nausea and vomiting occur in many patients with vertebrobasilar insufficiency. It is impossible to fight them with medications. The mechanism of dyspeptic disorders is compression of the vertebral artery with impaired blood supply to the intestines;
3. Disorders of the central nervous system - memory loss, changes in visual acuity, eye pain;
4. Vestibular disorders – disorientation, tinnitus;
5. Changes in the frequency of contractions of the cardiovascular system, instability of pressure, attacks of angina.

In addition to operational and conservative treatment, patients with vertebrobasilar insufficiency need to undergo an additional complex medical procedures– physiotherapy, massage, kinesiotherapy (treatment with physical movements).

Narrowing of both vertebral arteries is a dangerous pathology in which serious complications develop.

X-ray of the cervical spine in a lateral projection with a decrease in the height of the vertebral bodies at the lower level

Difficulties are caused by timely diagnosis of nosology. To identify the disease, not only x-rays are used, but also other radiation methods diagnostics

Principles of treatment of vertebral artery syndrome

When both vertebral arteries are narrowed, treatment is aimed at eliminating the main pathogenetic links of the process:

1. Elimination of neurogenic spasm;
2. Improving microcirculation of the vertebrobasilar area;
3. Vertebrogenic effect on the tone of the vascular wall.

Complex treatment necessarily includes agents that reduce blood viscosity and dilate blood vessels - dipyridamole, pentoxifylline, vinpocetine.

X-rays with narrowing of the right or left vertebral artery are not used to diagnose the disease, but to identify possible reason compression of the vertebral vessel in the neck.

Methods for detecting compression of vertebral vessels (right and left)

Methods for diagnosing stenosis of vertebral vessels on both sides:

1. Magnetic resonance imaging allows you to determine anomalies in the structure of the bone bed in which the vessels run;
2. X-ray of the cervical spine - to identify vertebral instability, displacement, neck hernia, and other anatomical structures that interfere with blood flow in the vertebrobasilar region;
3. Doppler sonography helps evaluate deviations of blood flow from normal values. The more the circulation is reduced, the greater the likelihood of severe complications in the brain;
4. Duplex scanning – is prescribed to identify lesions localized on the inner wall of the vessel;
5. Angiography of the cervical vessels - a study after the introduction of contrast into the vessel. CT or MRI may be used for imaging, as the methods allow for the creation of a three-dimensional simulation of the condition of the neck.

To determine the level of blood supply disturbance in the area of the base of the brain, a ultrasound scanning with Dopplerography. The procedure is used not only to identify blood supply disorders, but also for the purpose of dynamic monitoring of the nature of microcirculation during treatment with vasodilator drugs.

Neuroimaging through magnetic resonance imaging can be used to identify changes in the brain that lead to similar symptoms.

MRI angiography is considered a fairly promising method that shows the condition of the transcranial and brachiocephalic arteries. The study allows you to carefully study the nature of the cerebral blood supply, identify blood clots, and stenosis of the vertebral artery. Magnetic tomography reveals atherosclerotic plaques, determine the features of angiography.

X-ray of the cervical spine is used in conjunction with MRI for additional diagnostics. To obtain maximum information, it is recommended to perform functional tests at maximum extension and flexion.

Vertebral artery syndrome is a complex of symptoms that occurs when the blood supply to the brain is disrupted as a result of damage to one or two vertebral arteries.

ICD-10	G45.0
ICD-9	435.3
DiseasesDB	29497
MedlinePlus	001423
eMedicine	emerg/834
MeSH	C10.228.140.300.150.956

A symptom complex is not a separate disease, but a collection of a number of symptoms that are present in a patient during a certain period of time and have a common development mechanism. Each syndrome may be characteristic of one or more diseases.

General information

Treatment of vertebral artery syndrome is carried out by vertebrologists - doctors whose field of activity is the treatment of diseases of the spine and musculoskeletal system.

Gerenbauer wrote in 1903 that turning the head to the side causes compression of the contralateral vertebral artery at the level of the atlas body. In the 60s of the XX century. B. Chrast, J. Korbicka established a decrease in blood flow in the vertebral artery when the head is flexed and extended, as well as a decrease in blood flow in the homolateral artery when the head is tilted to the side and a decrease in blood flow in the contralateral artery when the head is turned.

Vertebral artery syndrome, according to Ya.Yu. Popelyansky (1989), is detected in 26.6% of patients who suffer from cervical osteochondrosis (the second most common dystrophic-degenerative pathology of the spine).

Osteochondrosis of the spine itself, according to vertebrologists from different countries, is detected in 70% of the adult population.

Forms

Depending on the cause of occurrence, vertebral artery syndrome is divided into:

compression form, which occurs when mechanical pressure is applied to the artery wall;
irritative form, the cause of which is a reflex spasm of the artery that occurs in response to irritation of sympathetic fibers;
angiospastic form, in which a reflex spasm is caused by irritation of receptors located in the area of the motor segments of the cervical spine (less associated with head turns);
mixed form.

In practice, combination options are most often identified:

Compression-irritative form, in which compression of the artery is caused by mechanical compression of the vertebral artery and its nerve plexus. Narrowing of the artery occurs due to vascular spasm and extravascular (extravasal) compression.
A reflex-angiospastic form, in which the development of arterial spasm is associated with a reflex response that occurs when the afferent structures of the spinal nerve are irritated. Pathological processes in the intervertebral discs and intervertebral joints lead to irritation of the receptors, and the resulting flow of pathological impulses is sent to the sympathetic plexus of the vertebral artery and vertebral nerve, provoking vasospasm. In this form, the spasm of the vertebrobasilar arteries forming the vertebrobasilar system is more pronounced than in the presence of compression.

Depending on the clinical picture and the degree of blood supply disturbance (hemodynamics), vertebral artery syndrome is divided into:

The functional stage, in which patients suffer from headaches accompanied by vegetative disorders (acute pulsating, constantly aching or sharply intensifying with prolonged static load or sudden turning of the head). Pain often spreads from the back of the head to the forehead. Cochleovestibular disorders are also observed (systemic or paroxysmal dizziness is present), visual disturbances (darkening in the eyes, sparks, a feeling of sand in the eyes), and a slight decrease in hearing is possible.
Ischemic or organic stage, in which transient and persistent hemodynamic disorders of the brain are detected. It develops as a result of prolonged and prolonged episodes of vascular disorders, as a result of which persistent foci of ischemia are formed. Hemodynamic transient disorders are accompanied by dizziness, nausea, vomiting and speech disorder. When tilting or turning the head, ischemic attacks (drop attacks) occur, which are accompanied by a fall while maintaining consciousness. Syncopal episodes, in which there is a loss of consciousness lasting up to 10 minutes, are also observed. In a horizontal position, symptoms usually regress. After ischemic attacks, the patient may experience weakness, autonomic disorders and tinnitus.

Focusing on clinical types, they distinguish:

Posterior cervical spastic syndrome (Baré-Lieu syndrome), in which the headache is localized in the cervico-occipital region and radiates to the front of the head. Pain occurs in the morning (especially if the patient slept on an uncomfortable pillow), while walking, when driving a car, and when turning the neck. It can be pulsating in nature, localized in the cervical-occipital region and radiate to the parietal, temporal and frontal part heads. When turning the head, pain may intensify, and vestibular, visual and autonomic disturbances are possible.
Basilar migraine, in which vertebral artery syndrome occurs as a result of stenosis of this artery. The headache is paroxysmal in nature. The attack is characterized by a sharp headache in the occipital region, which is accompanied by vomiting. Loss of consciousness, dizziness, ataxia, visual disturbances and speech disorder are also possible.
Vestibulocochlear syndrome, in which persistent and decreased perception of whispered speech associated with head movements, systemic and non-systemic dizziness are observed.
Ophthalmic syndrome, which is characterized primarily by visual disturbances (decreased vision, lacrimation as a result of conjunctival hyperemia). When the head position changes, visual fields may be lost.
Syndrome of autonomic changes, which is accompanied by a feeling of heat, a feeling of cold extremities, sweating, changes in skin dermographism, and sleep disturbances.
Transient ischemic attacks (observed at the ischemic stage of vertebral artery syndrome), which are accompanied by transient motor and sensory disturbances, visual impairment (including bilateral blindness in half the visual field), impaired coordination of movement, attacks of dizziness, nausea, vomiting, speech and swallowing disorders .
Unterharnscheit syndrome, in which syncope occurs as a result of acute disorder blood circulation in the area of the reticular formation. A short-term loss of consciousness occurs when you suddenly turn your head.
An episode of drop attack that occurs when there is a circulatory disorder in the caudal parts of the brain stem and cerebellum. The resulting paralysis of all limbs (tetraplegia) is associated with throwing back the head. Motor functions are restored quite quickly.

Reasons for development

Vertebral artery syndrome can develop when various diseases, which can be divided into two groups. The first group includes diseases associated with the spine (vertebrogenic vertebral artery syndrome):

osteochondrosis (dystrophic disorders in articular cartilage);
spondylosis (growth of vertebral tissue in the form of spines);
protrusion (bulging intervertebral disc into the spinal canal with preservation of the fibrous ring);
intervertebral disc herniation, in which the nucleus pulposus of the intervertebral disc is displaced and accompanied by rupture of the fibrous ring;
vertebral displacement, in which the vertebral bodies are displaced relative to each other and relative to the vertical axis;
traumatic injuries;
scoliosis of the cervical spine.

Vertebrogenic type vertebral artery syndrome can also occur with congenital anomalies of vertebral development (Kimmerly's anomaly, which is characterized by the presence of an additional bone arch in the cervical spine, etc.).

The non-vertebral type of syndrome can occur when:

atherosclerosis, which is associated with the deposition of cholesterol and other fats in the form of plaques and plaques;
abnormalities of vascular development;
vascular spasms.

The most commonly observed vertebral artery syndrome is cervical osteochondrosis.
Predisposing factors to the appearance of symptoms in the presence of these conditions are sudden turns and tilts of the head, which provoke significant unilateral compression of the vessel.

Pathogenesis

The pathogenesis of vertebral artery syndrome is associated with anatomical structure spine and surrounding ligaments, muscles, nerves and blood vessels.

Blood enters the brain through two internal carotid arteries and two vertebral arteries, and blood flows out through two jugular veins.

Through the vertebral arteries, which form the vertebrobasilar basin and supply the posterior parts of the brain, 15–30% of the required blood volume enters the brain.

The vertebral arteries, originating in the thoracic cavity, enter the transverse foramen of the sixth cervical vertebra and pass through the overlying cervical vertebrae along the bone canal (the bone canal is formed by the transverse processes of the cervical vertebrae). The vertebral arteries enter the cranial cavity through the great foramen magnum, merging in the area of the basilar groove of the bridge into the main (basilar) artery.

Since the vertebral arteries supply blood to the cervical spinal cord, medulla oblongata and cerebellum, insufficient blood supply causes symptoms characteristic of damage to these parts (tinnitus, dizziness, disturbance of body statics, etc.).

Since the vertebral arteries contact not only the structure of the spine, but also the surrounding spinal column soft tissues, vertebral artery syndrome differs in different development mechanisms.

The vertebral artery is divided into intracranial and extracranial sections, a significant part of which passes through the mobile canal formed by the vertebral foramina. The Frank nerve (sympathetic nerve) is located in the same canal, the posterior trunk of which is localized on the posteromedial surface of the vertebral artery. Due to this arrangement, when the receptors of the spinal motion segment are irritated, a reflex response of the wall of the vertebral artery occurs. In addition, at the level of the atlas and axis (vertebrae C1 and C2), the vertebral arteries are covered only by soft tissue, which, combined with the mobility of the cervical spine, increases the risk of developing compression effects on the arteries from surrounding tissues.

Degenerative changes in the cervical spine resulting from osteochondrosis, deforming spondylosis, proliferation of osteophytes and other pathologies are often the cause of compression of the vertebral arteries.

In most cases, compression is detected at the level of 5-6 vertebrae, but can also be observed at the level of 4-5 and 6-7 vertebrae. In addition, vertebral artery syndrome often develops on the left side, since the development of atherosclerosis is more often observed in the vessel extending from the aortic arch. The additional cervical rib is also more often detected on the left side.

Symptoms

The main symptoms of vertebral artery syndrome include:

Headache, which in most cases is localized in the occipital region, but can be localized in the parietal and frontal regions. The pain may be accompanied by nausea and vomiting, and a certain position of the head helps reduce pain.
Dizziness, loss of balance, tinnitus (vestibular disorders).
Visual impairment (decreased visual acuity, photopsia).
Pain in the neck.
Arterial hypertension, which occurs as a result of insufficient oxygen supply to the medulla oblongata. Oxygen starvation stimulates the heart and leads to increased blood pressure. At the initial stage, the increase in pressure is compensatory in nature, but then the situation worsens, since with an increase in blood pressure, the blood flow is not able to overcome the mechanical barrier.
Transient ischemic attacks, which are accompanied by speech impairment and sensory and motor disorders.

In the reflex-angiospastic form, vertebral artery syndrome can manifest itself:

headaches of a vascular nature, the appearance of which is influenced by stress, endocrine cycles, overheating, weather conditions and fluctuations in total blood pressure;
syncope attacks of Unterharnscheidt, in which fainting occurs after moving the head, a feeling of heat and a feeling of “fullness” in the head, photopsia and dizziness;
cochleovestibular disorders (dizziness), which appear when the head position changes;
visual disturbances (flickering scotoma, fog before the eyes, pain in the eye, photophobia, lacrimation), laryngopharyngeal symptoms (tingling in the throat, perversion of taste, tickling sensation, cough, dysphagia);
changes in mental sphere(senestopathic experiences, asthenic, anxious-hypochondriacal and sometimes hysterical states).

Vertebral artery syndrome against the background of cervical osteochondrosis (compression-irritative form of the syndrome) manifests itself:

Headaches and paresthesias of hemicranic type. Headaches are characterized by irradiation like “removing the helmet” and paroxysmal aggravation with certain movements in the cervical spine, with tonic tension of the neck muscles and prolonged monotonous position of the head.
Painful contracture of the neck muscles and a crunching sensation in the neck that occurs when moving (symptoms of cervical osteochondrosis). The presence of compression radicular syndromes and cervical myelopathy is possible.
Cochleovestibular disorders that develop as a result of damage to the peripheral, stem and supranuclear vestibular formations.
Visual and oculomotor disturbances (narrowing of visual fields).
Various variants of Wallenberg–Zakharchenko syndrome.
Bouts of “drop attacks”.
Hypothalamic disorders.

Diagnostics

Diagnosis of the syndrome is quite difficult, since diagnostic errors are possible due to insufficient examination of patients with vestibulo-atactic or cochlear syndrome.

The diagnosis of vertebral artery syndrome is made based on the following criteria:

neurological manifestations relate to the vertebrobasilar vascular system;
clinical symptoms refer to one of 9 clinical options or combinations thereof and depend on the position of the cervical spine and its movements;
MRI or MSCT in the cervical spine visualizes morphological changes that can be the cause of the syndrome.
Using ultrasound, the presence of changes in blood flow is detected, which occurs as a result of performing functional tests (flexion-extension of the head and head rotation).

Diagnostics include:

X-ray of the cervical spine;
MRI of the brain;
Doppler ultrasound.

Treatment

Vertebral artery syndrome is treated with:

Drug therapy aimed at reducing perivascular (localized around the vessels) edema resulting from mechanical compression. Venous outflow is regulated by taking troxerutin, ginkgo biloba, and diosmin. Non-steroidal anti-inflammatory drugs (celecoxib, etc.) are also prescribed. To improve blood supply to the brain, vinpocetine or vincamine (vinca derivatives), trental (purine derivatives), calcium antagonists or alpha-blockers are prescribed.
Neuroprotective therapy that helps improve energy processes in the brain and minimize the risk of neuronal damage as a result of episodic circulatory disorders. For this purpose, Cerebrolysin or other drugs that improve regeneration, cholinergic drugs (gliatilin), metabolic drugs (trimetazidine, etc.) are prescribed.
Symptomatic therapy, which may include the use of muscle relaxants, anti-migraine drugs, etc.
Surgical methods that are used in case of severe compression of the arteries (with a herniated disc or the presence of an osteophyte) and the lack of effect when using other treatment methods.
Non-drug methods (physiotherapy, massage, acupuncture, hirudotherapy, manual therapy and exercise therapy).

Massage for vertebral artery syndrome is performed in the neck and collar area (performed every six months to a year, starting from the subacute period of the disease).

Exercises for vertebral artery syndrome are selected by your doctor individually, since both excessive and insufficient physical activity may harm the patient. In addition, it is important to remember that in the acute period of the disease, active movements are contraindicated.

Gymnastics for vertebral artery syndrome may include:

turns and tilts the head to the sides;
nodding;
moving the head forward and backward;
shoulder shrugs and other exercises affecting the shoulder joint;
hand pressure on the head opposite the turn;
circular movements of the head.

All movements are performed 5-10 times.

Exercises aimed at relaxing, stretching and strengthening the neck muscles (self-resistance) are also carried out, but they are indicated only during the recovery period.

Treatment of vertebral artery syndrome folk remedies must be combined with drug treatment. From traditional methods can be used:

Coniferous baths, for which pine, fir, spruce or cedar needles are used. Take a pine bath that relieves muscle spasms and improves blood flow for 20-30 minutes.
Taking an infusion of oregano, which is brewed at the rate of 2 tbsp. spoons of herbs per 1 liter of boiling water and leave for 12 hours (overnight). Throughout the day, the infusion is drunk in 4 doses.

Prevention

Prevention of vertebral artery syndrome includes:

daily exercise;
sleeping on an orthopedic pillow and mattress;
timely massage courses;
timely treatment of osteochondrosis.

The vertebral artery is a paired vessel that arises from the subclavian artery and, together with the carotid arteries, provides blood supply to the brain.

With vascular anomalies, the preconditions are created for a decrease in cerebral blood flow. This is exactly what happens with hypoplasia of the right vertebral artery, and what is it? Hypoplasia is the underdevelopment of an organ, which results in a decrease in its functionality. In the case of the vertebral artery, hypoplasia occurs when the diameter of the vessel decreases to less than 2 mm. This type of anomaly is congenital and is often a consequence of pregnancy pathology.

Symptoms often appear only in adulthood due to deterioration in the elasticity of blood vessels and the addition of atherosclerosis. In such a situation, there may be a decrease in blood flow to certain parts of the brain. To a certain extent, the pathology of the blood supply can be compensated, but defense mechanisms the body may become depleted or fail to function in emergency situations.

There are usually no differences from lesions of the left vertebral artery. The only difference is that right-sided lesions of the vessel occur several times more often than left-sided ones - according to some observations, in a ratio of approximately 3 to 1.

CT scan image

It is difficult to give a definite answer about the danger of the condition. Brain neurons are especially sensitive to malnutrition due to impaired blood supply. Therefore, hypoplasia of the arteries leading to the brain can lead to more serious consequences for the body compared to the underdevelopment of other vessels. The degree of danger depends on the severity of hypoplasia and associated health problems (vascular diseases, pathology of the cervical spine, heart disease).

Complete cure disease is impossible, even after surgery only temporary compensation of local blood flow can be achieved.

Neurologists usually treat hypoplasia of the vertebral arteries. IN medical care Only those patients in whom hypoplasia is manifested by certain symptoms of deterioration of cerebral circulation are needed. If there is a significant narrowing of the lumen of the vessel with severe symptoms of circulatory disorders, consultation with a vascular surgeon is necessary to decide on the need for surgery.

Causes of hypoplasia of the right vertebral artery

Underdevelopment of vertebral vessels is often detected accidentally during examination in adulthood. However, this pathology is congenital. Vascular underdevelopment can lead to various problems with the health of a pregnant woman, injuries during pregnancy, hereditary predisposition.

List of possible causes of vertebral artery hypoplasia:

Infections suffered during pregnancy: rubella, influenza, toxoplasmosis.
Bruises or injuries to the mother.
Drinking alcohol, taking medications during pregnancy, smoking, drug addiction.
Genetic characteristics that increase the risk of developing defects in the circulatory system.

The pathology can be asymptomatic for a long time. If the circulatory disturbance and symptoms are insignificant, the condition may be mistakenly attributed to other pathologies: osteochondrosis, vegetative-vascular dystonia.

Hypoplasia is considered one of the most common anomalies of the vertebral arteries. Data on the prevalence of hypoplasia among the population differ in different sources and range from 2.5 to 26.5% of cases. But it is known that hypoplasia of the vertebral artery on the right is noticeably more common than on the left or on both sides at the same time. This is probably due to the anatomical features of the formation of vascular formations. The vessel on the right departs from the subclavian artery at an acute angle, on the left almost at a right angle, the diameter of the right artery is often smaller than the left, and its length is greater.

The asymptomatic course of the anomaly of the right vertebral artery indicates sufficient compensation of blood flow due to the existing connections (anastomoses) between the vessels and due to the developed network of collaterals - branches of other vessels supplying blood to the same areas as the vertebral artery. Ensuring uniform blood flow to all parts of the brain is achieved largely due to the presence of closed circulatory systems, when the arteries of different vascular basins merge with each other. The listed protective mechanisms often compensate for insufficient blood flow through the right vertebral artery for a long time. Therefore, clinical manifestations often appear gradually as age-related changes develop.

Symptoms of pathology

The symptoms of this disease are very diverse and can vary significantly from patient to patient.

Here are several groups of symptoms:

Characteristics of disease manifestations:

Pain in pathology can vary significantly in intensity and other characteristics.
Patients often feel throbbing or shooting pain spreading from the neck and back of the head to the temporo-frontal areas.
The pain intensifies when turning the head, at night and after waking up.
Often hypoplasia is manifested by dizziness, a feeling of disorientation, and a distortion of the perception of the body’s position in space. Such episodes are often associated with head tilts and sudden movements. They can lead to staggering or even falling.
Sudden attacks of dizziness are sometimes accompanied by loss of consciousness and fainting.

In addition to pain, the following disorders may occur in pathology:

blurred vision, pain in the eyes, double vision, feeling of sand or flashing spots;
hearing impairment, tinnitus, sensorineural hearing loss, vestibular disorders;
problems with the cardiovascular system;
mood swings, depression;
fatigue, weakness;
sleep disturbance;
weather sensitivity.

Arterial hypertension and angina attacks are not always a direct consequence of an abnormality of the vertebral vessels. Typically, the combination of cardiac pathology with hypoplasia leads to a worsening of the disease. In this case, reduced blood flow in the vertebrobasilar region provokes episodes of myocardial ischemia and an increase in blood pressure.

Hypoplasia of the right vertebral artery increases the risk of developing a cerebral stroke due to impaired blood flow in the vertebrobasilar system and due to damage to the vascular wall in the event of atherosclerosis.

Treatment methods

In the case of vascular hypoplasia, complete cure of the disease is impossible. Even after reconstructive surgery, only temporary compensation of local blood flow can be achieved.

Conservative therapy

Conservative treatment includes medications, physiotherapeutic methods, physical therapy, and acupuncture. To improve blood supply to the brain, several groups of drugs are used:

Vasodilators (Cavinton, Actovegin, Ceraxon).
Neuroprotectors and nootropics (piracetam, glycine, picamilon, mexidol) that improve metabolic processes in brain tissue.

Betahistine, effective in the presence of dizziness.

Antihypertensive drugs are necessary in case of increased blood pressure: calcium antagonists (amlodipine), beta-blockers (bisoprolol), ACE inhibitors (angiotensin-converting enzyme) (lisinopril).

Prevention of blood clots is carried out with the help of antiplatelet agents (aspirin, pentoxifylline, clopidogrel).

Physiotherapeutic methods can be used:

diadynamic currents;
magnetic therapy;
electrophoresis with drugs that have a vasodilator and analgesic effect.

Surgery

Surgery can be performed openly or using the endovascular method (through small holes, without large incisions).

To restore blood flow, use:

Stenting, in which a stent - a frame - is inserted into the site of narrowing of the vessel to widen the narrowed area. Such stents can be impregnated with drugs.
Angioplasty, in which a balloon is inserted into the narrowed area and inflated with air to widen the vessel. Angioplasty and stenting can complement each other.
IN difficult situations A more complex reconstructive operation is performed: removal of the deformed area and prosthetics using the patient’s own vein.

Forecast

The prognosis for the pathology of hypoplasia of the right vertebral artery depends on the degree of underdevelopment, compensatory mechanisms of the body, and concomitant pathologies. In the absence of symptoms of deterioration in cerebral blood flow or minimal manifestations of pathology, the prognosis can be considered conditionally favorable.

Hypoplasia is considered a predisposing factor for the development of stroke. According to statistics, 70% of transient cerebrovascular accidents and 30% of strokes are associated with impaired blood flow in the vertebrobasilar system. Therefore, detecting an anomaly requires taking active preventive measures, especially in the presence of other risk factors.

The presence of pronounced manifestations of vertebrobasilar insufficiency significantly worsens the prognosis. If conservative therapy is insufficiently effective, only surgery. Good results are obtained using the endovascular method, which can be performed even in patients at high “surgical risk.”

Narrowing of the vertebral artery: right, left

With early diagnosis of vertebral compression and proper treatment, irreversible changes in brain tissue are prevented. Through this vessel blood flows to the brain tissue. About 20% of the structures are fed by blood supply from the vertebral arteries on the right and left, passing through the openings of the transverse processes of the vertebrae of the neck.

1. Dyspeptic symptoms (vomiting, nausea);

2. Pain syndrome of the cervical-occipital part;

3. Peripheral tenderness (helmet removal symptom);

4. Strengthening the clinic when sleeping on a pillow;

1. Headache syndrome is characterized by dull, burning pain localized in the parieto-occipital region. The symptom intensifies with severe physical activity. The probable location of pain is the superciliary, temporal, parietal areas;

2. Symptoms from the gastrointestinal tract. Nausea and vomiting occur in many patients with vertebrobasilar insufficiency. It is impossible to fight them with medications. The mechanism of dyspeptic disorders is compression of the vertebral artery with impaired blood supply to the intestines;

3. Disorders of the central nervous system - memory loss, changes in visual acuity, eye pain;

4. Vestibular disorders – disorientation, tinnitus;

1. Elimination of neurogenic spasm;

2. Improving microcirculation of the vertebrobasilar area;

1. Magnetic resonance imaging allows you to determine anomalies in the structure of the bone bed in which the vessels run;

2. X-ray of the cervical spine - to identify vertebral instability, displacement, neck hernia, and other anatomical structures that interfere with blood flow in the vertebrobasilar region;

3. Doppler sonography helps evaluate deviations of blood flow from normal values. The more the circulation is reduced, the greater the likelihood of severe complications in the brain;

4. Duplex scanning – is prescribed to identify lesions localized on the inner wall of the vessel;

To determine the level of blood supply disturbance in the area of the base of the brain, an ultrasound scan with Doppler sonography is performed. The procedure is used not only to identify blood supply disorders, but also for the purpose of dynamic monitoring of the nature of microcirculation during treatment with vasodilator drugs.

Second opinion of medical experts

Examples of conclusions
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Vertebral artery stenosis: symptoms

Possible consequences of vertebral artery stenosis and treatment of narrowing

Congenital or acquired vertebral artery stenosis is pathological disorder, leading to ischemic disease and cerebral stroke.

The difficulty of therapy lies in the fact that in the early stages of the disease there are practically no symptoms. Drug treatment brings relief only in 30-40% of cases.

The positive effect of prescribing drugs is temporary. Complete cure is possible only after surgery.

What is spinal stenosis

Literally, the term stenosis refers to a blockage, blockage, or narrowing of a blood vessel. As a result of the disturbances, blood flow becomes difficult and the intensity of the supply of nutrients and oxygen to the brain decreases.

Signs of stenosis of the left vertebral artery canal begin to appear after the internal cavity of the vessel narrows by more than 50%.

Since the vertebral artery provides about 35-40% of the total blood supply to the brain, chronic failure occurs, evidenced by characteristic symptoms:

Headaches - migraine crises are accompanied by dizziness and loss of vision clarity. The pain syndrome is not relieved with conventional analgesics.
Lower back pain is one of the first symptoms of spinal vascular stenosis. The intensity worsens during walking and physical activity. The pain does not go away when stopping or at rest. A decrease in pain is observed when the back is tilted forward.
Numbness of the limbs. With the development of pathology and continued narrowing of the distal section, restless legs syndrome (pins and needles sensation), muscle weakness, and tingling are observed. Usually discomfort disappear when changing body position, especially when bending forward.
An increase in blood pressure occurs due to the body’s independent attempts to ensure normal blood supply to the brain. With prolonged hypertension, symptoms characteristic of arterial hypertension are observed: decreased visual acuity, impaired motor coordination, etc.

Appearance clinical manifestations indicates that pathological changes have become life-threatening for the patient.

There are three main causes of vertebral artery stenosis:

Congenital factor - genetic predisposition leads to congenital disorders in the structure of blood vessels.

If the disease does not progress, people with such stenosis live a full life, with virtually no restrictions.

The acquired factor is one of the main reasons why treatment of vertebral artery stenosis is required.

Blockage of blood vessels can be caused by atherosclerosis, diabetes and metabolic disorders.

Traumatic factor. Narrowing of the artery occurs due to bruise, fracture, or hematoma at the site of injury.

Surgical treatment is required to eliminate the causes of artery blockage.

How dangerous is the disease?

The prognosis of the disease is extremely unfavorable and mainly depends on the localization of pathological changes. Critical stenosis of the right vertebral artery leads to a stroke and death is possible. The progressive form of the disease is a criterion for disability.

Regardless of whether surgical treatment was performed, the patient in the later stages of stenosis is placed in the disability group. Disability may be prescribed taking into account the consequences of stenosis (severe stroke, etc.

)Methods of treating the disease and the consequences of stenosis largely depend on its location.

Estuary stenosis is characterized by serious emotional disturbances: attacks of panic fear of death, frontal pressing pain and associated irritability, photophobia. Depending on the causes of pathological changes, surgical intervention and drug therapy in the preoperative period are recommended.
Subcompensated stenosis - mainly occurs as a result of a traumatic factor. It is impossible to cure with drug therapy; surgical correction is necessary. Another common cause of development is cancer. In this case, the pathology often ends in death.
Vertebrogenic stenosis - characteristic features is pain in the lower back and area sacral region. Stenosis is not accompanied by inflammatory processes. MRI shows signs of moderate atrophy of the frontal cortex.
Compensated stenosis - the development of pathology is slow, there are no signs acute form diseases. As a result, there is no need for urgent surgical intervention.
Intracranial stenosis is accompanied by arterial thrombosis. Under unfavorable circumstances, the disease progresses rapidly and a stroke occurs.
Stenosis of extravasal compression of the left vertebral artery - develops as a result of abnormal diseases of the spine. The cause of development may be cervical osteochondrosis, hernia, cancer and other pathologies. After eliminating the causes of the disease, blood supply is usually restored.
Stenosis of extravasal compression of the right vertebral artery - for this diagnosis, the etiology and causes of development are identical to the narrowing observed in the left side of the spine.
Dynamic stenosis - accompanied by complete or partial occlusion of the vessel. It is extremely dangerous for the patient's life. Drug therapy treats only symptoms and is mainly used to prepare the patient for surgery.
Functional stenosis - symptoms occur only in a certain position of the neck. The development of the disease occurs only against the background of osteochondrosis, spondylosis and other disorders of the structure of the spine.
Multifocal stenoses are multiple vascular lesions. Surgery is ineffective. Drug therapy is prescribed, and if it is ineffective, angioplasty with complete replacement of damaged parts of the arteries
Hemodynamically significant stenosis is a condition in which there is a narrowing of blood vessels of more than 50%. The result is a condition that affects normal blood flow and, accordingly, brain activity.
Decompensated stenosis is one of the most severe conditions. The narrowing of the lumen of blood vessels takes a chronic form and becomes irreversible. The only possible solution is to completely replace the damaged section of the artery or create a backup channel.

Before prescribing treatment methods, it is necessary to carry out differential diagnosis to determine the exact cause of the development of disorders, the degree of development and form of the disease. Classification of the degree of stenosis plays an important role in determining the advisability of prescribing surgery.

What methods are used to treat the disease?

There are three main areas of treatment for spinal vascular stenosis.

Drug therapy - prescribed vascular drugs, promoting the development of elasticity and strength, medications for blood pressure control, thinning the blood and helping to reduce blood clots.

At the same time, physical therapy is used in complex therapy, manual therapy and hirudotherapy.

Surgical intervention - surgical correction is performed to eliminate complications after injuries and disorders in the structure of the spine.

Stenosis is also treated with stenting. A metal frame is inserted into the artery to prevent rupture and further narrowing of the vessel. The duration of operation of stents is about 15 years. To reduce the likelihood of rejection, the steel frame is coated with plastic.

To prevent stenosis, it is enough effective method therapy.

To prescribe the optimal type of therapy, the attending physician refers to several diagnostic procedures.

One of the most informative ways to obtain a complete picture of pathological changes is duplex scanning of the arteries. In addition, an MRI of the stenosis may be required.

Ultimately, the decision of what to treat depends on the patient himself. If the patient experiences constant dizziness, chronic lack of air, vasoconstriction of more than 70%, these are absolute indications for surgery.

What diet is optimal for treatment

The therapeutic diet is aimed at overcoming the causes of narrowing of the arteries. There is no specially designed diet.

Instead, you should eat as much fish (of any variety), fruits and vegetables as possible. You should be careful when drinking alcohol, coffee and tea.

It has been observed that losing just a few kilograms of weight reduces the risk of rapid development of stenosis due to atherosclerosis. Physiotherapy is one of the best ways to normalize the patient's weight.

Although many developments have recently appeared aimed at overcoming stenosis, surgery remains the only highly effective method of combating the disease.

Spinal artery stenosis: left, right, what it is, symptoms

Vertebral artery stenosis is a narrowing of the artery, as a result of which blood circulation in the brain is disrupted, nutritional deficiency occurs, oxygen starvation nerve cells (neurons) and ischemic stroke. The vertebral arteries (VA) are one of the main vessels that run along both sides of the spine (left and right arteries) and supply the brain with blood (up to 25% of the total volume of blood entering the head).

The essence of pathology

Chronic insufficiency occurs when there is a shortage of 35-40% of blood and is characterized by the following symptoms:

dizziness, migraines that are not affected by analgesics;
deterioration of vision - phenomena of floaters, dark spots or visual images before the eyes;
deterioration of memory and intellectual abilities;
impaired coordination of movements due to damage to the cerebellum;
lumbar pain, aggravated by walking and physical exercise subsiding when bending forward;
a feeling of numbness in the limbs, tingling and “pins and needles” in the legs, weakness in the muscles;
arterial hypertension;
pain in the cervical-occipital region.

If the vertebral artery is narrowed by half, then the patient’s condition worsens, sudden attacks loss of consciousness and circulatory failure, during which some brain cells die.

Reasons for the development of stenosis

According to the factors that provoked the development of stenosis, 3 main groups are classified:

Hereditary pathologies associated with blood vessels. In the absence of exacerbation, the disease does not manifest itself and the person remains active throughout his life.
Stenosis acquired as a result of diseases affecting blood circulation (atherosclerosis, diabetes and metabolic disorders).
Narrowing of arterial walls due to injury (bruise, fracture, hematoma).

Reasons for the development of stenosis:

diseases that cause degeneration and dystrophy of the vertebral columns of the cervical region (osteochondrosis, spondylosis, ankylosing spondylitis), leading to confusion of the vertebrae and disruption of brain microcirculation;
atherosclerosis blood vessels due to the concentration of cholesterol plaques in the vascular cavity;
tumors of the vertebral processes;
bone growths (osteophytes) in the joints of the intervertebral space;
hypertonicity and spasms of the cervical and scalene muscles.

Depending on the affected areas, the following types of VA stenosis are distinguished:

Estuary stenosis is a form of damage to the vertebral arteries on the right or left, accompanied by mental disorders that manifest themselves in outbreaks of panic attacks, fear of death, compression pain in the frontal part, irritability and fear of light. The main treatment is surgical.
Subcompensated stenosis is provoked by injuries and resulting displacements in the cervical spine. Surgery is necessary to correct post-traumatic complications. If the lesion is caused by an oncological tumor, then such a disease ends in death.
Vertebrogenic stenosis is characterized by the manifestation of pain in the lumbar and sacral regions of the spine without any inflammatory processes and moderate changes in the frontal lobe of the cerebral cortex. The vertebral vessel is examined using MRI. Treatment is surgical through stenting through a puncture of the femoral artery and installation of an endoprosthesis.
Compensated stenosis is characterized by a slow course of the disease, when the lumen of the vessel walls narrows gradually and makes it possible to treat the disease with medication, without surgery.
Intracranial stenosis - causes arterial thrombosis, rapidly progresses and provokes a stroke.
Narrowing of the left vertebral artery is a consequence of abnormal changes in the spine (cervical osteochondrosis, intervertebral hernia, cancerous tumors). The prognosis when the sources of disease development are completely eliminated is favorable, the blood supply to the brain tissue is restored.
Right vertebral artery stenosis - symptoms and treatment are similar to stenosis on the left side of the spine.
Dynamic narrowing of the VA - is expressed in complete or partial disruption of the patency of the arteries and is considered the most dangerous looking stenosis Treatment with drugs is only symptomatic; emergency surgical care is required.
Functional stenosis - manifests itself only in a certain position of the neck, progresses due to existing osteochondrosis, spondylosis and other lesions of the spine.
Multifocal stenoses are lesions of several or many vessels. Apply only drug therapy or angioplasty, which involves replacing diseased tissue in the arteries.
Hemodynamic vasoconstriction means that the obstruction has affected more than half of the vessel, which disrupts the functioning of the brain.
Decompensated stenosis - the disease becomes chronic, the process becomes irreversible. The prognosis is relatively favorable with complete replacement of the narrowed section of the arterial vessel or the creation of an alternative blood flow channel.
Stenosis of the spinal canal due to its narrowing. This type of stenosis is observed in the lumbar region and causes compression of the nerve roots of the lumbar plexus and neuralgia sciatic nerve. It can also be observed in the cervical spinal cord, squeezing the latter, which can lead to complete paralysis.

Diagnosis of insufficiency of cerebral blood supply

To study the blood circulation of the brain, the following instrumental methods are used:

Dopplerogram of the vessels of the cervical spine to identify processes of narrowing of the arteries;
angiography - the introduction of contrast agents into the vessels and their x-ray to exclude atherosclerotic and anatomical disorders of the vascular system;
magnetic resonance angiography - scanning of contrast arteries;
CT using a contrast solution injected into the artery to determine the degree of stenosis;
Contrast panangiography is an X-ray using contrast agents to identify the presence and location of a blood clot for surgery.

Treatment of the disease

Narrowing of the vertebral artery is a disease that requires timely treatment, otherwise complications can lead to ischemic stroke. Treatment of stenosis is prescribed based on the reasons that caused pathological processes, and type of stenosis.

Drug therapy involves influencing the signs of the disease, suppressing their manifestation: drugs that lower blood pressure are used (Indap, Lozap, Dibazol, etc.

); orthopedic collars that limit the mobility of the cervical vertebrae; anticoagulants; means for normalizing blood circulation (Cinnarizine, Mildronate, Encephabol, Vasobral, Instenon, etc.); NSAIDs.

However drug treatment effective only in 30-40% of cases, and there is a danger of regression of the disease.

Surgical intervention involves various types of operations depending on the course and localization of the process of narrowing of the vascular walls. Among them:

Endarterectomy - resection of damaged sections of the artery and insertion of an implant (stent).
Reconstructive operations - arteriolysis, resection and redressing of damaged sections of the VA.
Stabilization of the movement of the moving part of the spine.
Removal of osteophytes - bone growths in intervertebral joints.
Stenting is the insertion of a metal frame covered with plastic into the artery canal, which protects the vessel walls from narrowing.
Fixation of the cervical spine when removing some articular elements by installing special titanium systems.

Prognosis of VA stenosis

The prognosis of the disease in the vast majority of cases is quite unfavorable, the outcome is influenced by location degenerative changes in PA.

Critical stenosis of the right VA usually results in a stroke with possible death.

Patients who have suffered this illness are assigned a disability.

Symptoms and treatment of vertebral artery stenosis

Vertebral artery stenosis is a disease that can be either congenital or acquired.

The most common and serious complications in this case are coronary heart disease and stroke.

And the difficulty of treating such a pathology is that initial stages There are almost no symptoms at all.

The term itself means nothing more than a blockage, obstruction or narrowing of blood vessels.

As a result, there is a violation of blood flow, as a result of which the brain receives an insufficient volume of blood, and therefore oxygen and nutrients.

The first signs begin to appear when the narrowing of the artery reaches 50%, and even with a lack of 40% of the total blood supply, chronic failure occurs, which is manifested by the following symptoms:

Headaches accompanied by dizziness, loss of visual acuity and clarity. Moreover, it is impossible to relieve the pain syndrome with analgesics or other drugs.
Lower back pain. This is one of the main symptoms of narrowing of the spinal vessels. The intensity becomes maximum when walking, during physical activity, and the pain does not disappear even at rest. A pose in which the back is tilted forward helps to reduce it.
Numbness of the extremities, which manifests itself in restless legs syndrome, muscle weakness, tingling. Most often, such manifestations disappear after changing body position.
High blood pressure is an attempt by the body to independently compensate for the lack of blood flow to the brain.

All these manifestations mean that pathological changes in the vessels have reached a life-threatening stage for the patient.

Causes

Spinal artery stenosis does not occur without a cause. There are currently three known reasons for its development.

In the first case, this is a congenital factor, that is, a genetic predisposition that leads to some congenital abnormalities in the structure of the vessel.

If the disease does not progress, then people with such pathologies can live for many years without limiting themselves in anything.

The second reason is an acquired factor. This is the very reason that requires mandatory treatment. Atherosclerosis can cause blockage, diabetes, metabolic disorders.

And finally, the third factor is traumatic. Narrowing of the artery can occur due to a fracture, bruise, or hematoma. In this case, surgical treatment is mandatory.

How dangerous

In the presence of symptoms, the prognosis of vertebral artery stenosis is extremely unfavorable. A progressive form is always a reason for disability. But the treatment will completely depend on where exactly the pathology is localized.

The mouth form is always emotional disturbances, which can be expressed in panic attacks, photophobia. The main treatment is surgical; drug therapy is required before surgery.

The subcompensated form occurs as a complication of traumatic injury. Drug treatment is not possible, only surgery is necessary. Another fairly common reason is oncology. In this case, most often the patient dies literally within a year.

Vertebrogenic stenosis is characterized by pain in the lower back and sacrum. At the same time, any inflammatory processes cannot be detected.

The compensated form proceeds slowly, there are no signs of acute onset, and there is no need for urgent surgical treatment.

Intracranial stenosis occurs with arterial thrombosis and usually leads to death.

Left extravasal compression stenosis is a consequence of spinal diseases. The cause may be osteochondrosis, hernia, or oncology. After eliminating the causes, blood supply is most often restored to normal volume.

Stenosis of extravasal compression on the right has the same reasons as the previous option.

The dynamic type is accompanied by complete or partial occlusion of blood vessels. This is the most life-threatening condition. Medicines can only help overcome the symptoms themselves, but the pathology can only be cured through surgery.

The functional symptom begins to manifest itself only in one position or another of the neck. The disease is based on spondylosis, osteochondrosis and other disorders.

Multifocal stenoses have numerous causes. The only way out– angioplasty with replacement of a section of the damaged artery.

Hemodynamically significant stenosis is observed when the vessel narrows by more than 50%.

The decompensated form is one of the most severe, when the narrowing of blood vessels is completely irreversible. The only way out is to completely replace the affected area or create a bypass channel for blood flow.

Treatment of vertebral artery stenosis begins after diagnosis and determination of the type of disease. Surgery is most often used; drug treatment is used extremely rarely.

Narrowing of the vertebral artery: right, left | Second opinion

With early diagnosis of vertebral compression and proper treatment, irreversible changes in brain tissue are prevented.

Through this vessel blood flows to the brain tissue.

About 20% of the structures are fed by blood supply from the vertebral arteries on the right and left, passing through the openings of the transverse processes of the vertebrae of the neck.

MRI of the cervical spine in a patient with vertebrobasilar insufficiency

X-ray with narrowing of the lumen of the vertebral artery: right or left

Traditional radiography with narrowing of the lumen of the vertebral arteries (right or left) does not show pathological manifestations. Neurologists send patients with certain clinical symptoms for imaging:

1. Dyspeptic symptoms (vomiting, nausea); 2. Pain syndrome of the cervical-occipital part; 3. Peripheral tenderness (helmet removal symptom); 4. Strengthening the clinic when sleeping on a pillow;

5. Shooting, throbbing pain when externally applied to the head (touch, wind).

In patients with vertebral artery stenosis, neurologists often observe vestibular syndrome, in which staggering, instability, and severe attacks of dizziness are observed.

Even with an uncomplicated course, a short-term loss of consciousness is possible with a sharp turn of the head, vibration, or pressure on the neck. A person with such clinical symptoms should not drive a car.

Noise, nausea, hearing loss affect everyday life as a manifestation of a number of secondary pathologies from the inner ear and brain.

Traditional radiography of the cervical spine visualizes narrowing of the intervertebral discs during a degenerative-dystrophic process, prolapse, or hernia.

For these purposes, functional photographs are taken with maximum flexion and extension of the neck.

X-rays help assess the degree of cervical flexion and exclude or confirm vertebral instability.

Lateral radiographs of the cervical spine examine the condition of the cervical vertebrae, intervertebral spaces, and hyperlordosis (excessive convexity of the natural curvature).

With any of these disorders, decreased vision, eye fatigue, and pathology of the visual analyzer are observed.

With late therapy, it is impossible to prevent the irreversible development of visual impairment using either conservative or surgical methods. X-rays of the cervical spine do not show shadows of the vessel.

To study the state of blood supply, contrast angiography, magnetic resonance imaging, and Doppler sonography are required.

Methods for radiological diagnosis of stenosis of the right or left vertebral artery will be discussed below.

Why does narrowing of the vertebral artery develop?

The cause of impaired blood supply to the vertebrobasilar area may be tortuosity of one or both vertebral arteries. To treat the pathology, stenting and balloon angioplasty are used.

Until a few years ago, stenting was performed under X-ray control. A scopic cover was used to visualize the insertion of the balloon stent.

The movement of the balloon from the femoral to the vertebral artery is clearly visible on the X-ray television screen.

The procedure led to radiation exposure of the patient, so at the present stage the intervention is monitored under the guise of ultrasound.

Narrowing of the left vertebral artery: symptoms

Narrowing of the left vertebral artery can be suspected if the following symptoms are present:

1. Headache syndrome is characterized by dull, burning pain localized in the parieto-occipital region. The symptom intensifies with severe physical activity.

The probable location of pain is the superciliary, temporal, parietal areas; 2. Symptoms from the gastrointestinal tract. Nausea and vomiting occur in many patients with vertebrobasilar insufficiency.

It is impossible to fight them with medications. The mechanism of dyspeptic disorders is compression of the vertebral artery with impaired blood supply to the intestines; 3.

Disturbances of the central nervous system - memory loss, changes in visual acuity, eye pain; 4. Vestibular disorders – disorientation, tinnitus;

5. Changes in the frequency of contractions of the cardiovascular system, instability of pressure, attacks of angina.

In addition to surgical and conservative treatment, patients with vertebrobasilar insufficiency need to undergo an additional set of treatment procedures - physiotherapy, massage, kinesiotherapy (treatment with physical movements).

Narrowing of both vertebral arteries is a dangerous pathology in which serious complications develop.

X-ray of the cervical spine in a lateral projection with a decrease in the height of the vertebral bodies at the lower level

Difficulties are caused by timely diagnosis of nosology. To identify the disease, not only x-rays are used, but also other radiation diagnostic methods.

Principles of treatment of vertebral artery syndrome

When both vertebral arteries are narrowed, treatment is aimed at eliminating the main pathogenetic links of the process:

1. Elimination of neurogenic spasm; 2. Improving microcirculation of the vertebrobasilar area;

3. Vertebrogenic effect on the tone of the vascular wall.

Complex treatment necessarily includes agents that reduce blood viscosity and dilate blood vessels - dipyridamole, pentoxifylline, vinpocetine.

X-rays with narrowing of the right or left vertebral artery are not used to diagnose the disease, but to identify the possible cause of compression of the vertebral vessel in the neck.

Methods for detecting compression of vertebral vessels (right and left)

Methods for diagnosing stenosis of vertebral vessels on both sides:

1. Magnetic resonance imaging allows you to determine anomalies in the structure of the bone bed in which the vessels run; 2.

X-ray of the cervical spine - to identify vertebral instability, displacement, neck hernia, and other anatomical structures that interfere with blood flow in the vertebrobasilar region; 3. Doppler sonography helps evaluate deviations of blood flow from normal values.

The more the circulation is reduced, the greater the likelihood of severe complications in the brain; 4. Duplex scanning – is prescribed to identify lesions localized on the inner wall of the vessel;

5. Angiography of the cervical vessels - a study after the introduction of contrast into the vessel. CT or MRI may be used for imaging, as the methods allow for the creation of a three-dimensional simulation of the condition of the neck.

To determine the level of blood supply disturbance in the area of the base of the brain, an ultrasound scan with Doppler sonography is performed.

The procedure is used not only to identify blood supply disorders, but also for the purpose of dynamic monitoring of the nature of microcirculation during treatment with vasodilator drugs.

Neuroimaging through magnetic resonance imaging can be used to identify changes in the brain that lead to similar symptoms.

MRI angiography is considered a fairly promising method that shows the condition of the transcranial and brachiocephalic arteries.

The study allows you to carefully study the nature of the cerebral blood supply, identify blood clots, and stenosis of the vertebral artery.

Magnetic tomography reveals atherosclerotic plaques, determine the features of angiography.

X-ray of the cervical spine is used in conjunction with MRI for additional diagnostics. To obtain maximum information, it is recommended to perform functional tests at maximum extension and flexion.

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Narrowing of the vertebral arteries

As a result of narrowing of the vertebral arteries, insufficiency of arterial blood supply to the brain may occur.

The atherosclerotic mechanism of cerebral circulatory disorders, according to De Bachi, is observed in approximately 40% of cases of all cerebral circulatory disorders.

Occlusions arterial vessels can be partial or complete; The length of the blockage can be short or long, along the entire length of the artery.

Symptoms of narrowing of the vertebral artery

Occlusion of the vertebral artery is manifested by signs of insufficiency of the arterial vessels of the base of the brain: visual disturbances (cortical origin) and symptoms of cerebellar damage (equilibrium imbalance, diplopia, bilateral blindness or hemianopsia), as well as bilateral disturbances of sensitivity and movement, expressed differently. These disturbances may be transient or permanent.

The diagnosis of sclerotic narrowing of the vertebral arteries can be suspected during a routine clinical examination of the patient based on his medical history (transient neurological symptoms - paresis and paralysis, “flickering symptoms”), systolic murmur on the arterial vessels, a symptom of loss of consciousness with unilateral compression of the carotid artery.

With electroencephalography, pathological changes are found only with pronounced neurological symptoms, which reduces the value of this research method.

In some cases, electrical activity increases when the carotid artery of the other side is pressed or the head is raised sharply.

Topical diagnosis using electroencephalography is impossible.

The most accurate data on the localization and distribution of the lesion can be obtained from arteriography of the vertebral arteries.

It should be performed as early as possible, especially after an attack of cerebral arterial insufficiency, and if the symptoms of cerebral ischemia do not go away, then this study is carried out as an emergency intervention.

Arteriography of the vertebral artery is done by percutaneous puncture of the subclavian artery in the supraclavicular region. Inject 20 ml of 50% triyotrast.

It is necessary to examine the arterial vessel on the other side, since bilateral lesions occur in at least 25% of cases. X-ray done at the end of the administration of the contrast solution.

The study is then carried out on the opposite side.

Partial narrowing of the vertebral artery, visible on the arteriogram in the form of “filling defects”, “corrosion” of the contours of the artery wall, is an indication for surgery. If there is a complete blockage, the vessel is not filled with contrast solution and is completely invisible on the arteriogram.

Treatment of narrowing of the vertebral artery

The success of surgical treatment depends primarily on how early the operation is performed after the onset of the disease.

In some cases, the operation is successful even in the later period. The purpose of the operation is to restore blood supply to the brain.

Two types of surgery are used: endarterectomy or bypass with a plastic prosthesis.

Intimendarterectomy - removal of the altered intima along with the sclerotic plaque and the thrombus layered on it.

Endarterectomy of the vertebral artery, due to its small caliber, is performed from the lumen of the subclavian artery.

For this purpose, the latter is cut longitudinally above the origin of the vertebral artery.

In the case of simultaneous occlusion of the artery of the same name on the opposite side, special measures are required to protect the brain from ischemia during the operation.

For this purpose, a temporary external or internal (through the lumen of the artery) shunt with a thin polyethylene tube is applied. In addition, the decrease in blood flow is compensated by increasing blood pressure by administering norepinephrine.

Blood clotting in the temporary bypass is prevented by administering heparin.

In most cases, however, no special brain ischemia treatment is required for the period of surgical intervention (5-30 minutes), since the collateral blood supply is quite sufficient.

The operation brings either complete relief from the symptoms of insufficient blood supply to the brain, or a significant improvement in the condition. The results of treatment, followed over 5 years, remained stable.

The best effect is observed after surgery performed at the stage of sclerotic narrowing of the vessel, and not its occlusion. If the vessel is completely blocked, the operation is successful if it is performed soon after the onset of the disease.

Improved diagnosis and earlier access to surgical help will further improve the results of surgical treatment of sclerotic lesions of the main arterial vessels supplying the brain.

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symptoms, treatment and icd 10

The method of therapy and combating its consequences directly depend on the form of the disease and its location. Vertebral artery stenosis can be:

Causes of the disease

There are three main causes of vertebral artery stenosis:

Genetic predisposition. It can lead to congenital disorders of the vascular structure itself. If the disease does not progress, then they live a full normal life with it, without obvious restrictions.
Acquired factor. The following pathologies provoke blockage of blood vessels: atherosclerosis, metabolic disorders and diabetes. For this reason, mandatory treatment of the vertebral artery is necessary.
Traumatic factor. Narrowing of the vertebral artery artery can occur due to contusion, fracture, or hematoma formation at the site of injury. In this case, surgical treatment must be prescribed to eliminate the causes of artery blockage.

The causes of the disease are related to the intrauterine development of the child:

Symptoms

The syndrome is expressed in a unique way, so patients note the following symptoms:

It can be burning or pulsating, spreading to the temple, crown or superciliary area.

Feature: the pain is localized either in the right or left side of the head. The pain plagues the patient constantly, but is especially intensified while walking or during sleep, if the position of the head or body predisposes it to this.

Much less often the pain is paroxysmal in nature. Patients often say that the pain has stopped, but they could not find a logical explanation for this. The reason for this is the position of the head. But there aren't any general rules about what position the head should be in order for the pain to disappear;

visual disturbances (decreased sharpness, feeling of sand in the eyes, blurred vision) or pain in the eyeballs;
auditory or vestibular disorders, for example, dizziness, loss of stability, noise in one ear, hearing loss;
cardiac manifestations if the person has cardiovascular diseases, for example, hypertensive heart disease, ischemic.

If a patient suffers from coronary heart disease, angina attacks may occur in the form of acute pain in the heart area.

The development of the syndrome, in which the vertebral artery suffers, occurs in two stages - dystonic and organic. Symptoms and treatment for each stage vary and it is important to determine the extent of arterial damage by studying information about the signs of the disease.

In the first case, a person begins to feel symptoms such as:

constant pain in the temporal and occipital areas of the head, which intensifies with movements or being in one position for a long time;
transient dizziness of varying intensity;
disturbances of visual perception, expressed in the appearance of “flies”, “snowflakes”. There is also a unilateral decrease in peripheral visual acuity.

Signs of the organic course of the disease have the following symptoms:

Diagnostics

Diagnosis of vertebral artery syndrome involves several different tests.

First of all, diagnosis is based on the data that can be obtained from the clinical picture of the disease. We are talking about the patient’s complaints, as well as the information that was obtained by the doctor during a neurological examination.

Quite often, diagnosis reveals tension in the neck muscles, difficulty turning the head, and pain when pressing on the processes of the first and second cervical vertebrae.

In addition, diagnosis means mandatory:

Circulatory disorders in the vertebral artery are diagnosed by Doppler ultrasound (USD). The method for studying the arteries of the vertebrobasilar and carotid basins is called ultrasound scanning of the branches of the aortic arch. In this case, the carotid arteries are fully examined, and the vertebral arteries are partially examined.

Most often, the examination begins with a blood test, which shows possible problems with the arteries.

Also, a standard procedure is to measure blood pressure; this indicator can not only identify arterial hypertension, but also determine the load on blood vessels, and therefore clarify risk factors for various diseases.

After this, additional diagnostics may be prescribed.

The disease can be identified during the first examination by a neurologist. The doctor listens to the patient's complaints about general state, takes into account possible disorders in the cervical spine, and issues a referral for ultrasound diagnostics.

If during the examination a narrowing of the lumen in the diameter of the vertebral artery was revealed to 2 mm when the norm is 3.6 - 3.8 mm - this is considered diagnostic symptom proving the presence of the disease. If necessary, angiography is performed - X-ray diagnostics of blood vessels using injection contrast agent, clearly demonstrating their current state.

If a disease is suspected, the doctor must write a referral for a vascular ultrasound. This diagnostic allows you to determine the diameter of the artery.

A narrowing of the internal diameter is considered an anomaly; the norm varies in the range of 3.6 - 3.8 mm.

According to indications, tomography and angiography of the arteries are performed using a contrast agent.

These studies help to obtain full picture vascular abnormalities.

Often, hypoplasia is aggravated by disorders of the vertebrae located in the cervical region. This can also be detected during diagnostics.

The following methods allow you to set a competent one:

Treatment

Stenosis can be treated using three effective methods:

Modern medicine offers many methods of treating arteries, both conservative and surgical. However, these diseases still remain among the most severe and difficult to treat.

This is largely due to the fact that the processes taking place in the left and right arteries of the extremities main vessels, blood vessels of the brain and heart, are influenced by many factors, for example, the composition of the blood, the work of the heart muscle, the condition of the veins, age-related changes in tissues.

Therefore, treatment should be carried out comprehensively, taking into account all possible causes.

Depending on the stage of development and the presence of factors influencing the clinical picture, treatment of vertebral artery syndrome may be conservative or require surgical intervention. In the dystonic course of the syndrome, a good result is achieved by the medicinal method, in which the patient is given medications that stimulate blood flow and improve chemical composition blood.

At the same time, physical therapy can be prescribed, which will help increase the clearance between the walls of the arteries and eliminate the early stages of osteochondrosis.

In some cases, in the treatment of cervical osteochondrosis, special gymnastics deserves good reviews, which not only reduces discomfort, but also improves cerebral blood supply.

Treatment is carried out using two methods:

Conservative. It involves the introduction of drugs that improve blood properties, blood supply to the brain and metabolic processes in it. Such methods do not completely eliminate the disease, but only provide protection to the brain from ischemic abnormalities. For this purpose, various medications are used, in particular blood thinners.
Surgical. Used in situations where it is impossible to compensate for cerebral circulation in other ways. Experienced surgeons perform endovascular surgery, the meaning of which is to insert a stent into the lumen of a narrowed vessel. This is a special dilator that increases the diameter of the artery, normalizing blood flow.

To eliminate vascular manifestations, specialists prescribe drugs to patients that improve brain nutrition.

Medicines activate metabolic processes in nervous system, protect its cells from repeated action of the aggressor.

Conservative treatment only relieves symptoms - the consequences of vascular damage.

Prevention

Since atherosclerosis and coronary heart disease are chronic progressive diseases, it is very important to pay sufficient attention to prevention.

After all, this is how you can prevent the disease itself, as well as slow down its progression.

the goal of such measures is to optimize the composition of arterial blood so that it does not contain factors that contribute to the formation of plaques.

Nutrition

Try not to lift or hold heavy objects with outstretched arms. You need to learn how to carry weights correctly so as not to injure your back. With an even posture, you need to squat down, take the load and straighten your legs with it.

At the same time, place your hands as close to your body as possible. Distribute the load evenly, so you don't have to carry it in one hand if you can carry two bags in both hands.

Use bags, carts and rolling suitcases to transport heavy items.

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General information

Causes

Symptoms

Additional diagnostics

Treatment

Medication

Non-drug

Surgical

Symptoms of the disease

Dizziness

Noise in ears

Numbness

Fainting

Nausea

Depression

Signs of the syndrome in cervical osteochondrosis

Reasons for violations

Why is the syndrome dangerous?

Diagnosis and treatment of vertebral artery syndrome

Drug treatment

Surgical methods of treatment

Traditional methods

X-ray with narrowing of the lumen of the vertebral artery: right or left

Why does narrowing of the vertebral artery develop?

Narrowing of the left vertebral artery: symptoms

Principles of treatment of vertebral artery syndrome

Methods for detecting compression of vertebral vessels (right and left)

General information

Forms

Reasons for development

Pathogenesis

Symptoms

Diagnostics

Treatment

Prevention

Causes of hypoplasia of the right vertebral artery

Symptoms of pathology

Treatment methods

Conservative therapy

Surgery

Forecast

Narrowing of the vertebral artery: right, left

Second opinion of medical experts

Vertebral artery stenosis: symptoms

Possible consequences of vertebral artery stenosis and treatment of narrowing

What is spinal stenosis

How dangerous is the disease?

What methods are used to treat the disease?

What diet is optimal for treatment

Spinal artery stenosis: left, right, what it is, symptoms

The essence of pathology

Reasons for the development of stenosis

Diagnosis of insufficiency of cerebral blood supply

Treatment of the disease

Prognosis of VA stenosis

Symptoms and treatment of vertebral artery stenosis

Causes

How dangerous

Narrowing of the vertebral artery: right, left | Second opinion

X-ray with narrowing of the lumen of the vertebral artery: right or left

Why does narrowing of the vertebral artery develop?

Narrowing of the left vertebral artery: symptoms

Principles of treatment of vertebral artery syndrome

Methods for detecting compression of vertebral vessels (right and left)

Narrowing of the vertebral arteries

Symptoms of narrowing of the vertebral artery

Treatment of narrowing of the vertebral artery

Healthy:

symptoms, treatment and icd 10

Causes of the disease

Symptoms

Diagnostics

Treatment

Prevention

Nutrition

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