Vertebrobasilar Arterial System Research Articles

Diagnostic value of cervical vascular ultrasound in large arterial lesions of the neck in patients with transient ischemic attack

Objective To assess the diagnostic value of cervical vascular ultrasound in identifying large arterial lesions in patients with transient ischemic attack (TIA). Methods The current study matched 84 TIA patients (disease group) with 66 healthy controls (control group). The baseline patient profiles and biochemical indices of the patients were analyzed. All patients received color Doppler ultrasonography, and outcome measures of its diagnostic efficiency included plaque status, plaque properties, and the degree of carotid stenosis. The patients in the disease group were assigned to group A (TIA of the internal carotid artery system, n = 40) and group B (TIA of the vertebrobasilar artery system, n = 44), and the plaque distribution of the patients was analyzed. Results TIA patients had higher rates of diabetes, hypertension, hyperlipidemia, obesity, and smoking compared to controls (p < 0.05). Their serum TC, LDL-C, and FBG levels were significantly elevated, while HDL-C levels were decreased (p < 0.05). TIA patients had more plaques, especially soft plaques, than controls (p < 0.05). They also showed higher rates of moderate to severe carotid stenosis (p < 0.05). TIA involving the internal carotid artery system was associated with a higher risk of plaques at the entrance of the subclavian artery compared to TIA involving the vertebrobasilar artery system (p < 0.05). Conclusion The diagnostic value of cervical vascular ultrasound in patients with TIA is remarkable, and it provides a reliable monitoring approach as well as an essential screening modality for TIA. The rational use of this technique will markedly benefit the diagnosis, treatment, and prevention of TIA.

Neurovascular Complications of Iatrogenic Fusarium solani Meningitis

SummaryA multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in Mexico. The pathogen involved had a high predilection for the brain stem and vertebrobasilar arterial system and was associated with high mortality from vessel injury. Effective treatment options remain limited; in vitro susceptibility testing of the organism suggested that it is resistant to all currently approved antifungal medications in the United States. To highlight the severe complications associated with fusarium infection acquired in this manner, we report data, clinical courses, and outcomes from 13 patients in the outbreak who presented with symptoms after a median delay of 39 days.

Application of stimuli-responsive nanomedicines for the treatment of ischemic stroke.

Ischemic stroke (IS) refers to local brain tissue necrosis which is caused by impaired blood supply to the carotid artery or vertebrobasilar artery system. As the second leading cause of death in the world, IS has a high incidence and brings a heavy economic burden to all countries and regions because of its high disability rate. In order to effectively treat IS, a large number of drugs have been designed and developed. However, most drugs with good therapeutic effects confirmed in preclinical experiments have not been successfully applied to clinical treatment due to the low accumulation efficiency of drugs in IS areas after systematic administration. As an emerging strategy for the treatment of IS, stimuli-responsive nanomedicines have made great progress by precisely delivering drugs to the local site of IS. By response to the specific signals, stimuli-responsive nanomedicines change their particle size, shape, surface charge or structural integrity, which enables the enhanced drug delivery and controlled drug release within the IS tissue. This breakthrough approach not only enhances therapeutic efficiency but also mitigates the side effects commonly associated with thrombolytic and neuroprotective drugs. This review aims to comprehensively summarize the recent progress of stimuli-responsive nanomedicines for the treatment of IS. Furthermore, prospect is provided to look forward for the better development of this field.

Hemodynamic factors of spontaneous vertebral artery dissecting aneurysms assessed with numerical and deep learning algorithms: Role of blood pressure and asymmetry

Background and ObjectivesThe pathophysiology of spontaneous vertebral artery dissecting aneurysms (SVADA) is poorly understood. Our goal is to investigate the hemodynamic factors contributing to their formation using computational fluid dynamics (CFD) and deep learning algorithms. MethodsWe have developed software that can use patient imagery as input to recreate the vertebrobasilar arterial system, both with and without SVADA, which we used in a series of three patients. To obtain the kinematic blood flow data before and after the aneurysm forms, we utilized numerical methods to solve the complex Navier-Stokes partial differential equations. This was accomplished through the application of a finite volume solver (OpenFoam/Helyx OS). Additionally, we trained a neural ordinary differential equation (NODE) to learn and replicate the dynamical streamlines obtained from the computational fluid dynamics (CFD) simulations. ResultsIn all three cases, we observed that the equilibrium of blood pressure distributions across the VAs, at a specific vertical level, accurately predicted the future SVADA location. In the two cases where there was a dominant VA, the dissection occurred on the dominant artery where blood pressure was lower compared to the contralateral side. The SVADA sac was characterized by reduced wall shear stress (WSS) and decreased velocity magnitude related to increased turbulence. The presence of a high WSS gradient at the boundary of the SVADA may explain its extension. Streamlines generated by CFD were learned with a neural ordinary differential equation (NODE) capable of capturing the system’s dynamics to output meaningful predictions of the flow vector field upon aneurysm formation. ConclusionIn our series, asymmetry in the vertebrobasilar blood pressure distributions at and proximal to the site of the future SVADA accurately predicted its location in all patients. Deep learning algorithms can be trained to model blood flow patterns within biological systems, offering an alternative to the computationally intensive CFD. This technology has the potential to find practical applications in clinical settings.

Vascular reconstruction related to the extracranial vertebral artery: the presentation of the concept and the basis for the establishment of the bypass system.

The intracranial vertebrobasilar artery system has a unique hemodynamic pattern (vessel trunk converged bilateral flow with three groups of perforators directly arising from it), is embedded within intense osseous constraints, and is located far from conventional donor vessels. Two major traditional modalities of posterior circulation revascularization encompass the superficial temporal artery to the superior cerebellar artery and the occipital artery to the posteroinferior cerebellar artery anastomosis, which are extracranial-intracranial low-flow bypass with donor arteries belonging to the anterior circulation and mainly supply focal perforators and distal vascular territories. As our understanding of flow hemodynamics has improved, the extracranial vertebral artery-related bypass has further evolved to improve the cerebral revascularization system. In this article, we propose the concept of "vascular reconstruction related to the extracranial vertebral artery" and review the design philosophy of the available innovative modalities in the respective segments. V1 transposition overcomes the issue of high rates of in-stent restenosis and provides a durable complementary alternative to endovascular treatment. V2 bypass serves as an extracranial communication pathway between the anterior and posterior circulation, providing the advantages of high-flow, short interposition grafts, orthograde flow in the vertebrobasilar system, and avoiding complex skull base manipulation. V3 bypass is characterized by profound and simultaneous vascular reconstruction of the posterior circulation, which is achieved by intracranial-intracranial or multiple bypasses in conjunction with skull base techniques. These posterior circulation vessels not only play a pivotal role in the bypass modalities designed for vertebrobasilar lesions but can also be implemented to revascularize the anterior circulation, thereby becoming a systematic methodology.

GSI CTA evaluation of the vertebrobasilar artery in normal adults at high altitude.

Vascular geometry is influenced by several factors during its growth and development. Here, we compared the differences in vertebrobasilar geometry among residents of a plateau region at different altitudes and investigated the relationship between vascular geometry and altitude. Data of some adults in the plateau region who experienced vertigo and headache as the main symptoms but had no evident abnormalities found during imaging examination were collected. They were divided into three groups based on an altitude gradient: group A (1,800-2,500 masl), group B (2,500-3,500 masl), and group C (over 3,500 masl). They underwent head-neck energy-spectrum computed tomography angiography with a gemstone spectral imaging scanning protocol. The following indices were observed: (1) vertebrobasilar geometric configurations (walking, tuning fork, lambda, and no confluence), (2) vertebral artery (VA) hypoplasia, (3) the bending number of bilateral VA intracranial segment, (4) length and tortuosity of the basilar artery (BA), and (5) anteroposterior (AP)-mid-BA angle, BA-VA angle, lateral-mid-BA angle, and VA-VA angle. Of the 222 subjects, 84 of them were included in group A, 76 in group B, and 62 in group C. The number of participants in walking, tuning fork, lambda, and no confluence geometries was 93, 71, 50, and 8, respectively. As altitude increased, the tortuosity of the BA also increased (1.05 ± 0.06 vs. 1.06 ± 0.08 vs. 1.10 ± 0.13, P = 0.005), as did the lateral-mid-BA angle (23.18° ± 9.53° vs. 26.05° ± 10.10° vs. 31.07° ± 15.12°, P = 0.007) and the BA-VA angle (32.98° ± 17.85° vs. 34.51° ± 17.96° vs. 41.51° ± 19.22°, P = 0.024). There was a relatively weak positive correlation between the altitude and the tortuosity of the BA (rs = 0.190, P = 0.005), the lateral-mid-BA angle (rs = 0.201, P = 0.003), and the BA-VA angle (rs = 0.183, P = 0.006) which showed a significant difference. Compared with groups A and B, there were more multibending groups and fewer oligo-bending groups in group C (P < 0.001). There was no difference found in the vertebral artery hypoplasia, actual length of the BA, VA-VA angle, and AP-mid-BA angle among the three groups. As the altitude increased, the tortuosity of the BA and the sagittal angle of the vertebrobasilar arterial system also increased. The increase in altitude can lead to changes in vertebrobasilar geometry.

Traumatic basal subarachnoid haemorrhage

Traumatic basal subarachnoid haemorrhage (TBSAH) refers to a severe basal centred bleed, almost invariably resulting from a micro-tear or in exceptional circumstances a more lengthy dissection of the intracranial vertebrobasilar arterial system. This is typically caused by an impact to the side of the upper neck, angle of jaw and/or ear/mastoid region. TBSAH is typically associated with an immediate comatose state, often accompanied by the intervention of cardiorespiratory arrest. Delayed presentations are rare but do occur and may be related to dissections or traumatic false aneurysms. The forensic approach to cases of suspected TBSAH can be a very rewarding exercise if carried out with due diligence and technique as this may yield evidence informative on (i) any predisposing vasculopathy enhancing susceptibility to tearing, (ii) whether undue force was implicated and (iii) incontrovertible, pathognomonic evidence of a mechanical basis of rupture confirming overstretching of the vessel, thus ruling out natural disease such as a berry aneurysm. The main focus of this presentation will be to discuss optimum techniques addressing these issues. Whilst the source of haemorrhage is intracranial, best practice includes examination of the extracranial vertebral arteries which does not need to be an onerous task.

Automated Supra- and Infratentorial Brain Infarct Volume Estimation on Diffusion Weighted Imaging Using the RAPID Software.

PurposeThe present computerized techniques have limits to estimate the ischemic lesion volume especially in vertebrobasilar ischemia (VBI) automatically. We investigated the ability of the RAPID AI (RAPID) software on diffusion-weighted imaging (DWI) to estimate the infarct size in VBI in comparison to supratentorial ischemia (STI).MethodsAmong 123 stroke patients (39 women, 84 men, mean age 66 ± 11 years) having undergone DWI, 41 had had a VBI and 82 a STI. The infarct volume calculation by RAPID was compared to volume calculations by 2 neurologists using the ABC/2 method. For inter-reader and between-method analysis intraclass correlation coefficient (ICC), area under the curve (AUC) estimations, and Bland–Altman plots were used.ResultsICC between the two neurologists and each neurologist and RAPID were >0.946 (largest 95% CI boundaries 0.917–0.988) in the STI group, and > 0.757 (95% CI boundaries between 0.544 and 0.982) in the VBI group. In the STI group, AUC values ranged between 0.982 and 0.999 (95% CI 0.971–1) between the 2 neurologists and between 0.875 and 1 (95% CI 0.787–1) between the neurologists and RAPID; in the VBI group, they ranged between 0.925 and 0.965 (95% CI 0.801–1) between the neurologists, and between 0.788 and 0.931 (95% CI 0.663–1) between RAPID and the neurologists. Compared to the visual DWI interpretation by the neurologists, RAPID did not recognize a substantial number of infarct volumes of ≤ 2 ml.ConclusionThe ability of the RAPID software to depict strokes in the vertebrobasilar artery system seems close to its ability in the supratentorial brain tissue. However, small lesion volumes ≤ 2 ml remain still undetected in both brain areas.

Abnormalities of the Vertebrobasilar Arterial System Leading to Sleep Disorders

IntroductionThe abnormalities in the vertebrobasilar arterial system such as enlarged, tortuous or dilated arteries and aneurysms can generate pressure and distortion of brain structures especially in the medulla and pons. This brainstem compression by abnormal arteries can lead to various sleep disorders such as sleep related hypoventilation, central sleep apnea, obstructive sleep apnea, and positional sleep apnea. AimTo highlight brainstem compression due to vascular abnormalities as a cause of sleep disordered breathing. MethodsManuscripts were identified using the National Institutes of Health PubMed literature search system. Search terms included sleep disorders, vertebrobasilar dolichoectasia, tortuous vertebral arteries, vertebrobasilar aneurysms, vascular compression and brainstem compression. Inclusion criteria required that the articles were written in English, highlighted both a sleep disorder and a vascular abnormality. ResultsThe literature search resulted in 10 case reports where vascular abnormalities were leading to sleep disorders. Out of these: four patients had central sleep apnea; three had sleep related hypoventilation; one had positional central sleep apnea; one had positional central apnea along with obstructive sleep apnea; and one had obstructive sleep apnea. The various vascular lesions identified were: megadolichobasilar artery; dolichoectatic vertebral artery; fusiform vertebrobasilar aneurysm; tortuous and elongated vertebral arteries; calcified vertebral artery and medullary telangiectasia. ConclusionsArterial compression of the respiratory centers in the pons and medulla can lead to central sleep apnea. Obstructive sleep apnea can also result from vascular compression of the medulla. The proposed mechanism is compression of nucleus ambiguus which controls pharyngeal tone. Pressure on cranial nerves IX and X can lead to pharyngeal dysfunction leading to occlusive apnea.

Optimization of 4D-MR angiography based on superselective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) for vessel-selective visualization of the internal carotid artery and vertebrobasilar artery systems

PurposeThis study investigated the optimal labeling position and gradient moment for 4D-MR angiography based on superselective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) for vessel-selective flow visualization of the internal carotid artery (ICA) and vertebrobasilar artery (VBA) systems. MethodsSeven healthy volunteers were scanned with a 3.0 T MR scanner. To visualize the ICA system, the labeling focus was placed in the right ICA at 55, 75 and 95 mm below the imaging slab. To visualize the VBA system, the labeling focus was placed in the basilar artery (BA), upper vertebral artery (VA upper), and lower vertebral artery (VA lower). Two sizes of labeling focus were created using gradient moments of 0.5 and 0.75 mT/m ms. The contrast-to-noise ratio (CNR) was measured in the middle cerebral artery (MCA) and posterior cerebral artery (PCA) branches. ResultsCNRs increased as the distance between the center of the imaging slab and the labeling position decreased in all MCA segments. CNRs obtained with VA lower tended to be higher than those obtained with BA and VA upper in all PCA segments. Selective vessel visualization was achieved with the gradient moment of 0.75 mT/m ms for the ICA and VBA system. ConclusionThe optimal 4D-S-PACK gradient moment was found to be 0.75 mT/m ms for the ICA and VBA systems. When visualizing the ICA system, the labeling position should be placed as close as possible to the imaging slab. When visualizing the VBA system, the labeling position should be placed at VA lower .

Cerebral arterial fenestration associated with stroke and other cerebrovascular diseases.

Cerebral arterial fenestration is a rare vascular malformation that has not been fully understood. Whether it is related to cerebrovascular diseases remains to be determined. In this study, we aimed to investigate the imaging characteristics of cerebral fenestrations, the clinical characteristics of fenestrations complicated with cerebrovascular diseases, and the correlation between fenestrations and cerebrovascular diseases. We reviewed the magnetic resonance imaging and computed tomography (CT) imaging findings of patients with cerebrovascular fenestrations in the Third Affiliated Hospital of Soochow University from January 2016 to December 2020, mainly focused on the shape and location of fenestrations. According to the location of fenestrated arteries, patients were divided into the internal carotid arterial system (ICAS) group and the vertebrobasilar arterial system (VAS) group. For patients complicated with cerebrovascular diseases, detailed data about the demographics and clinical characteristics were recorded. Stroke patients with injured lesions located in the territories of fenestrated arteries were further screened out and analyzed. Moreover, the proportions of cerebrovascular diseases including stroke between the ICAS group and the VAS group were compared. A total of 280 cerebrovascular fenestrations were found in 274 patients (six patients had two fenestrations). The most frequently involved vessels were the anterior cerebral artery (123/280), the basilar artery (76/280) and the vertebral artery (35/280). As to the shape of fenestrations, slit-like fenestrations accounted for 63.2% (177/280), followed by convex-lens-like type 26.1% (73/280) and duplicated type 10.7% (30/280). A total of 70 patients were complicated with cerebrovascular diseases, including ischemic stroke 64.3% (45/70), hemorrhagic stroke 22.9% (16/70), aneurysm 10% (7/70), arteriovenous malformation 1.4% (1/70) and cavernous hemangioma 1.4% (1/70). There were no significant differences between the ICAS group and the VAS group in terms of the demographics and clinical characteristics. Furthermore, among the 61 patients complicated with stroke, 16 patients' stroke lesions were located in the territories of fenestrated arteries, including 12.5% (2/16) in the ICAS and 87.5% (14/16) in the VAS. In addition, compared with the ICAS group, the proportions of cerebrovascular diseases including stroke in patients with fenestrations were higher in the VAS group (P < 0.05). Cerebral arterial fenestrations are most commonly found in the anterior cerebral artery, the basilar artery and the vertebral artery. Vertebrobasilar fenestrations are more related to cerebrovascular diseases, especially stroke.

Маркери нейрогенного запалення в дітей iз синдромом вертебробазилярної артеріальної системи і рекурентними бронхітами

Актуальність. Дослідження особливостей нейрогенного забезпечення при рекурентних бронхітах (РБ) у дітей iз синдромом вертебробазилярної артеріальної системи (СВБАС) шляхом вивчення рівнів кінцевих стабільних метаболітів оксиду азоту (КСМ NO), субстанції Р і вазоактивного інтестинального пептиду (ВІП) надасть можливість встановити важливі елементи патогенезу частих захворювань респіраторного тракту. Мета дослідження: визначення особливостей нейрогенного забезпечення при рекурентних бронхітах у дітей iз СВБАС шляхом вивчення сироваткових рівнів КСМ NO, субстанції Р і ВІП. Матеріали та методи. Обстежено 60 дітей віком від 7 до 11 років iз РБ в анамнезi. Сформовано дві групи спостереження (по 30 пацiєнтiв у кожній): 1) діти з РБ у періоді соматичного благополуччя і СВБАС; 2) діти з РБ в періоді соматичного благополуччя без СВБАС. Результати. У пацiєнтiв iз РБ, які мають СВБАС, порівняно з дітьми без СВБАС статистично значуще частіше відзначається підвищення вмісту в сироватці крові КСМ NO (на 36,7 %, p &lt; 0,05) (вiдношення шансів (ВШ) = 6,50; 95% довiрчий інтервал (ДІ) 1,82–23,21, p &lt; 0,05), субстанції Р (на 40,0 %, p &lt; 0,05) (ВШ = 6,00; 95% ДІ 1,89–19,04, p &lt; 0,05), зниження концентрації ВІП (на 26,7 %, p &lt; 0,05) (ВШ = 3,05; 95% ДІ 1,05–8,84, p &lt; 0,05). Висновки. У дітей iз РБ і СВБАС у період соматичного благополуччя має місце вогнище нейрогенного запального процесу, що супроводжується дисбалансом автономних нейрональних процесів і схильністю до повторної захворюваності на бронхолегеневу патологію.

Взаємозв’язок сироваткового вмісту цитокінів і нейропептидів у дітей з рекурентним бронхітом і синдромом вертебробазилярної артеріальної системи

Актуальність. Наявність дисбалансу нервової регуляції у дітей зумовлює тяжкий клінічний перебіг бронхолегеневої патології. Вивчення нейроімунних взає­мин у дітей з синдромом вертебробазилярної артеріальної системи і гострими бронхітами дозволить встановити важливі елементи патогенезу даної комбінації. Мета дослідження: визначення нейроімунних взаємин у дітей з синдромом вертебробазилярної артеріальної системи, що сприяють формуванню частих повторних (рекурентних) гострих бронхітів. Матеріали та методи. Під спостереженням знаходилося 60 дітей віком від 7 до 12 років. Сформовано 2 групи спостереження (по 30 дітей у кожній): 1) діти з синдромом вертебробазилярної артеріальної системи, які хворіють на гострий бронхіт; 2) діти без синдрому вертебробазилярної артеріальної системи, які хворіють на гострий бронхіт. Результати. У дітей 1-ї групи порівняно з дітьми 2-ї групи частіше реєструється зниження фагоцитарного числа (на 56,7 %; р &lt; 0,05), фагоцитарного індексу (на 53,3 %; р &lt; 0,05), індексу завершеності фагоцитозу (на 66,7 %; р &lt; 0,05), стимульованого НСТ-тесту (на 40 %; р &lt; 0,05). При дослідженні адаптивного імунітету виявлено збільшення кількості дітей 1-ї групи з підвищеним вмістом в крові CD3+ (на 40 %; р &lt; 0,05), CD4+ (на 33,4 %; р &lt; 0,05), CD8+ (на 46,7 %; р &lt; 0,05), CD25+ (на 83,3 %; р &lt; 0,05), збільшенням в сироватці крові концентрації IgG (на 33,3 %; р &lt; 0,05) і IgМ (на 54,3 %; р &lt; 0,05) на тлі зниження IgА (на 40 %; р &lt; 0,05). У дітей 1-ї групи частіше реєструвався підвищений вміст в сироватці крові фактора некрозу пухлини a (на 70 %; р &lt; 0,05) і зниження інтерлейкіну 10 (на 40 %; р &lt; 0,05) одночасно зі збільшенням концентрації субстанції Р (на 40 %; р &lt; 0,05) і зниженням вазоактивного інтестинального пептиду (на 30 %; р &lt; 0,05). Висновки. У дітей з синдромом вертебробазилярної артеріальної системи, які хворіють на гострі бронхіти, має місце переважання в сироватці крові прозапальних цитокінів і нейропептидів з недостатністю протизапальних.

Pitfalls in the Diagnosis of Posterior Circulation Stroke in the Emergency Setting.

Posterior circulation stroke (PCS), caused by infarction within the vertebrobasilar arterial system, is a potentially life-threatening condition and accounts for about 20–25% of all ischemic strokes. Diagnosing PCS can be challenging due to the vast area of brain tissue supplied by the posterior circulation and, as a consequence, the wide range of—frequently non-specific—symptoms. Commonly used prehospital stroke scales and triage systems do not adequately represent signs and symptoms of PCS, which may also escape detection by cerebral imaging. All these factors may contribute to causing delay in recognition and diagnosis of PCS in the emergency context. This narrative review approaches the issue of diagnostic error in PCS from different perspectives, including anatomical and demographic considerations as well as pitfalls and problems associated with various stages of prehospital and emergency department assessment. Strategies and approaches to improve speed and accuracy of recognition and early management of PCS are outlined.

Vertebrobasilar Contribution to Cerebral Arterial System of Dromedary Camels (Camelus dromedarius).

It is hypothesized that in the “more highly evolved” mammals, including the domesticated mammals, that the brainstem and the cerebellum receive arterial blood through the vertebrobasilar system whilst the internal carotid arteries primarily supply the forebrain. In camels, the arterial blood supply to the brain differs from that of ruminants since the internal carotid artery and the rostral epidural rete mirabile (RERM) are both present and the basilar artery contributes a significant proportion of cerebral afferent blood. In this study, we described the anatomical distribution of the vertebrobasilar system arterial supply in the dromedary. Secondly, we determined the direction of blood flow within the vertebral and basilar arteries using transcranial color doppler ultrasonography. Thirdly, we quantified the percentage arterial contributions of the carotid and vertebrobasilar systems to the dromedary brain. Fifty-five heads of freshly slaughtered male Omani dromedaries aged 2–6 years were dissected to determine the distribution and topography of the arterial distribution to the brain. Their anatomical orientation was assessed by casting techniques using epoxy resin, polyurethane resin and latex neoprene. The epoxy resin and polyurethane resin casts of the head and neck arteries were used to measure the diameter of vertebrobasilar arterial system and carotid arterial system at pre-determined locations. These arterial diameters were used to calculate the percentage of blood supplied by each arterial system. The vertebrobasilar system in dromedary camels consists of paired vertebral arteries that contribute to the ventral spinal artery and basilar artery at multiple locations. In most specimens the vertebral artery was the primary contributor to the basilar artery compared to that of the ventral spinal artery. In four specimens the ventral spinal arteries appear to be the dominant contributor to the basilar artery. Transcranial color doppler ultrasonography confirmed that the direction of blood flow within the vertebral and basilar arteries was toward the brain in animals examined in ventral recumbency and when standing. The vertebrobasilar system contributes 34% of the blood supply to the brain. The vertebrobasilar system is the exclusive supply to the medulla oblongata, pons and cerebellum.

Association between the vertebrobasilar artery geometry and basilar artery plaques determined by high-resolution magnetic resonance imaging

BackgroundAtherosclerotic plaques are often present in regions of arteries with complicated flow patterns. Vascular morphology plays important role in hemodynamics. In this study, we investigated the relationship between the geometry of the vertebrobasilar artery system and presence of basilar artery (BA) plaque.MethodsWe enrolled 290 patients with posterior circulation ischemic stroke. We distinguished four configurations of the vertebrobasilar artery: Walking, Tuning Fork, Lambda, and No Confluence. Patients were divided into multi-bending (≥ 3 bends) and oligo-bending (< 3 bends) VA groups. The diameter of the vertebral artery (VA) and the number of bends in the intracranial VA segment were assessed using three-dimensional time-of-flight magnetic resonance angiography. High-resolution magnetic resonance imaging was used to evaluate BA plaques. Logistic regression models were used to determine the relationship between the geometry type and BA plaque prevalence.ResultsAfter adjusting for sex, age, body mass index ≥ 28, hypertension, and diabetes mellitus, the Walking, Lambda, and No Confluence geometries were associated with the presence of BA plaque (all p < 0.05). Patients with multi-bending VAs in both the Walking (20/28, 71.43% vs. 6/21, 28.57%, p = 0.003) and Lambda group (19/47, 40.43% vs. 21/97, 21.65%, p = 0.018) had more plaques compared to patients with oligo-bending VAs in these groups. In the Lambda group, the difference in diameter of bilateral VAs was larger in patients with BA plaques than that in patients without BA plaques (1.4 mm [IQR: 0.9–1.6 mm] vs. 0.9 mm [IQR: 0.6–1.3 mm], p < 0.001).ConclusionsThe Walking, Lambda, and No Confluence geometry, ≥ 3 bends in the VAs, and a large diameter difference between bilateral VAs are associated with the presence of BA plaque.

Drug and non-drug treatments of vertigo

Patients with complaints of “dizziness” often make an odyssey of visits to physicians belonging to various specialties. The prevalence of vertigo in the population is 17–30%. In most cases, disorders of various areas of the vestibular analyzer form the pathogenetic basis of vertigo and unsteadiness, while the most common cause of these complaints is the pathology of the peripheral area of the vestibular system: benign paroxysmal positional vertigo, vestibular neuronitis, Meniere’s disease. The cerebral vessel disease caused by hypertensive cerebral microangiopathy and cerebral atherosclerosis can also manifest by vertigo and unsteadiness. They can be represented by acute cerebrovascular disorders in the vertebrobasilar arterial system, transient ischemic attacks, as well as manifestations of chronic cerebrovascular disease (chronic cerebral ischemia, discirculatory encephalopathy). Episodes of recurrent spontaneous vestibular vertigo can be caused by vestibular migraine, which is rarely diagnosed in our country. The variety of reasons for complaints of vertigo and unsteadiness defines many therapeutic approaches to the treatment of these diseases. In recent times, modern drug and non-drug approaches to the treatment have been developed for patients with various diseases manifested by vertigo and unsteadiness. The most effective treatment is a comprehensive therapeutic approach that combines non-drug therapy, including vestibular gymnastics, training on the stabilographic platform with biofeedback according to the support reaction, and drugs that help reduce the severity, duration, and frequency of vertigo attacks, as well as accelerate vestibular compensation. Many studies have shown the efficacy of drugs enhancing microcirculation used for the prophylactic treatment of various causes of vertigo and unsteadiness.

Morphological characteristics of the vertebrobasilar artery system in patients with hemifacial spasm and measurement of bending length for evaluation of tortuosity

ObjectiveDominant vertebral artery (DVA), tortuosity, and elongation of the vertebrobasilar artery system are frequently observed in hemifacial spasm (HFS). However, the morphological characteristics of the tortuosity of vertebrobasilar artery system have not yet been elucidated. In this study, we presented a novel method for the measurement of the bending length (BL) of the basilar artery(BA) or vertebral artery (VA) to assess the tortuosity of vertebrobasilar artery system in HFS patients. MethodsThe demographic and morphological characteristics of 135 patients with HFS admitted to the neurosurgical department to undergo microvascular decompression (MVD) were analyzed in this retrospective study. The BL was defined to appraise the tortuous degree of the vertebrobasilar artery system, and according to the BL value, the patients with HFS were divided into two groups: tortuous vertebrobasilar artery (TVA) and non-TVA groups. Additionally, the vessels responsible for HFS were analyzed based on the results of magnetic resonance imaging (MRI) of the two groups. The patients were followed up for 2–6 years post-discharge, and the effect of MVD operation was compared between the two groups. ResultsDVA was detected in 60.2% of HFS patients; the incidence of left-sided HFS in the TVA group was significantly higher than that in the non-TVA group (P = 0.013). The proportion of multiple responsible vessels in the TVA group was 68.4% (54/79), while that in the non-TVA group was 4.1% (2/49). The complication rate of the two groups was different, and that of the tortuous group was higher than that of the non-tortuous group. ConclusionsThe morphological characteristics of the vertebrobasilar artery system in patients with HFS were complex. The measurement of BL is an easy and reliable tool to assess the tortuosity of the vertebrobasilar artery system in HFS patients.

Постинсультные нейропсихологические нарушения

The aim of research. The aim of the study was to evaluate neuropsychological disorders in patients with ischemic stroke in the acute period. Materials and methods. 100 patients with primary and repeated ischemic stroke in the carotid artery and vertebro-basilar arterial system in the acute period were examined. Patients did not have severe motor and speech disorders that could prevent neuro-psychological examination. The ischemic focus was visualized for 1–6 days from the onset of the disease by magnetic resonance imaging and computed tomography. Cognitive functions were assessed using a Mini Mental State Examination scale, a 10-word memorization test, and Schulte tables. Results. In the acute period of stroke, cognitive deficit was observed in 77% of cases and according to Mini Mental State Examination was 26.87±0.8 points in young patients, 22.83±0.8 points-in middle-aged patients. More pronounced disorders of higher brain functions were found in patients hospitalized during a period of more than 12 hours from the beginning of the disease clinic and amounted to 23.2±0.6 points. Conclusion. The study revealed that in the acute period of ischemic stroke, cognitive disorders were observed in 77% of cases, while late hospitalization of patients was accompanied by more pronounced violations of neuropsychological functions. And cognitive impairment was significantly prevalent in individuals of middle and old age compared to younger patients. Repeated stroke led to more significant not only neurological, but also cognitive impairment, which is associated with structural and functional damage to the substance of the brain and a decrease in the reserve capacity of the Central nervous system.

Change in basilar artery length and bending according to aging and vertebral artery dominance: A longitudinal study

This study aimed to investigate the basilar artery (BA) geometric changes in a longitudinal study. 154 subjects with normal vertebrobasilar arterial systems on magnetic resonance angiography were assigned into two groups: 1) non-dominant vertebral artery (VA) and 2) VA dominance. We defined the dominant VA as either that the VA is 3 millimeters larger in diameter or the VA is connected to BA in a more straight angle. BA imaging was segmented to obtain BA bending length (BABL) and BA length (BAL). A mixed model ANOVA was conducted to investigate the impact of aging and VA dominance on the change of BABL and BAL after 123.6 ± 16.2 months. There was a significant main effect of VA dominance on the change of BABL after about 10 years, F (1,152) = 39.78, p < 0.01. On the other hand, there was a significant main effect of aging on the change of BAL during the same period of time, F (1,152) = 6.64, p = 0.01. Most subjects had an opposite directional relationship between the dominant VA and BA bending (71.3%; p < 0.01). Our study supported the hypothesis that the bending of the BA depends on the dominance of the VA, whereas the increased length of the BA depends on aging.