Vertebrobasilar Insufficiency Patients Research Articles

Secondary Benefits of Microsurgical Intervention on the Vertebral Artery (V1 Segment) for Refractory Vertebrobasilar Insufficiency: Alleviation of Parkinsonism-Like Symptoms

ObjectiveTo investigate the outcomes of micro-neurosurgical interventions on V1 segment of vertebral artery (VA) in patients with refractory vertebrobasilar insufficiency (VBI) due to dolicoarteriopathy and external compressions and to assess the secondary benefits of Parkinsonism-like symptoms. MethodsRetrospective analysis encompassed 101 patients treated for VA dolicoarteriopathy or compression-related refractory VBI from 2016-2023. Of these, 16 patients exhibited drug-resistant Parkinsonism-like symptoms. The diagnostic evaluation included cerebral CT/MR angiography or DSA and brain CT or MR perfusion studies, corroborated by preoperative and 6- and 12-month postoperative MDS-UPDRS Part 3 assessments. Data was analyzed through Turkey's 'E-nabız' system, employing Stata16 for statistical scrutiny. ResultsA significant reduction in MDS-UPDRS scores was observed (preoperative: 26.75 ± 10.91; 6 months: 23.09 ± 9.24; 12 months: 22.5 ± 8.73; P<0.001). Postoperative follow-up denoted that 43.7% of patients ceased medication, and 50% reduced antiparkinsonian drugs. The micro-neurosurgical approach resulted in complete remission of VBI-related symptoms in 84.6% of patients, with the rest showing partial or marked improvement. At six months post-operation, perfusion studies revealed posterior border zone or cerebellar perfusion enhancements in 81% (13 out of 16) of patients, with full symptom resolution, while the remaining 19% (3 out of 16) showed partial perfusion and clinical improvements, particularly in regions supplied by the posterior cerebellar artery (PCA) or posterior inferior cerebellar artery (PICA). The absence of operative mortality and minimal transient morbidities underscored the procedure's safety. ConclusionMicroneurosurgery for VA anomalies in refractory VBI patients, particularly those with concomitant parkinsonian-like syndromes, has demonstrated potential in symptom remission and medication reduction.

Endovascular Approach in Treating Vertebrobasilar Insufficiency: A Systematic Review.

Vertebrobasilar insufficiency (VBI) is a significant medical condition that results from a lack of adequate blood flow to the posterior circulation of the brain. The first-line treatment involves the use of antiplatelet therapy, but in cases where patients are not responsive to drug therapy, surgical management is the next viable option. In the past, open endarterectomy was the preferred surgical approach for treating critical VBI patients. However, due to its high mortality rates and severe peri-procedural complications, its usage has decreased. Instead, the endovascular approach has emerged as an alternative surgical option for resolving VBI. This review explores the current literature to assess the effectiveness of endovascular interventions in treating VBI patients. It also highlights potential complications and adverse effects associated with these treatments while identifying gaps in the current research that warrant further investigation. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to extensively search relevant literature on endovascular approaches for treating VBI patients on PubMed, BioMed Central, and ClinicalTrials.gov. The findings suggest that endovascular treatments have demonstrated significant technical success in treating VBI, with low mortality rates and minor adverse effects, such as intracranial hemorrhage and restenosis. The overall incidence of these complications is relatively low. Combining medical therapies with endovascular interventions has improved outcomes and reduced restenosis rates. However, there are methodological limitations and inconsistencies in the current literature that necessitate further investigation. Future research should focus on larger, randomized clinical trials and direct comparisons with other treatment options to obtain more conclusive evidence.

Evaluation on the application of transcranial Doppler (TCD) and electroencephalography (EEG) in patients with vertebrobasilar insufficiency

BackgroundTo evaluate the diagnostic value of transcranial Doppler (TCD) and electroencephalography (EEG) in patients with vertebrobasilar insufficiency (VBI) during clinical diagnosis and treatmentMethodsEighty patients diagnosed with VBI in our hospital from June 2018 to December 2019 were randomly selected as the observation group, and 80 healthy people who received physical examination in the same period were selected as the control group. The abnormal rate, main performance and results, and the peak velocity of blood flow and vertebrobasilar artery blood flow of the two groups were compared.ResultsThe abnormal rate of EEG and TCD in VBI patients was 38.75% (31/80) and the 93.75% (75/80), respectively. In TCD examination, ACA, PCA, MCA, and VA of both sides of the observation group were higher than those of the control group, while BA was lower than that of the control group (P < 0.05). The Vs, Vd, and Vm on both sides of BA and VA in the observation group were lower than those in the control group, while PI and RI were higher than those in the control group (P < 0.05).ConclusionsTCD examination is highly sensitive to the degree and pattern of cerebral ischemia in VBI patients. EEG examination will define the changes of brain cell function after cerebral ischemia. Therefore, EEG and TCD have their own advantages. The application of TCD and EEG can be considered in the early diagnosis, curative effect, and prognosis evaluation of VBI patients, so as to improve the accuracy of diagnosis and prognosis.

Гемодинамические критерии оценки результата операции на позвоночных артериях у больных с вертебрально-базилярной недостаточностью

&lt;p&gt;&lt;b&gt;&lt;i&gt;Цель исследования &lt;/i&gt;&lt;/b&gt; – разработать критерии оценки эффективности операции реконструкции позвоночной артерии у больных с клиникой вертебрально-базилярной недостаточности (ВБН). &lt;p&gt;&lt;b&gt;&lt;i&gt;Материал и методы. &lt;/i&gt;&lt;/b&gt; Представлены результаты ультразвукового исследования объемного кровотока и индекса реактивности позвоночных артерий (ПА) у 194 больных с клиникой ВБН до и после выполнения различных реконструктивных операций при патологии 1-го сегмента ПА. Полученные результаты были сопоставлены с данными подобных исследований у 20 здоровых добровольцев. В работе предложен способ оценки дефицита объемного кровотока по позвоночным артериям и реактивности ПА, заключающийся в измерении суммарного объемного кровотока по ПА и определении в 3-м сегменте ПА индекса реактивности при пробе с задержкой дыхания. &lt;p&gt;&lt;b&gt;&lt;i&gt;Результаты. &lt;/i&gt;&lt;/b&gt; У здоровых и прооперированных пациентов с клиникой ВБН пороговое значение суммарной объемной скорости кровотока в ПА составляет 250 мл/мин. У пациентов с превышением этого значения в послеоперационном периоде симптомы ВБН нивелировались или определялся их значимый регресс (р&lt;0,05). Выявленная величина индекса реактивности 0,3 (30%) оказалась достоверной (р&lt;0,05) как у здоровых добровольцев, так и больных с клиническим улучшением после операций на 1-м сегменте ПА. &lt;p&gt;&lt;b&gt;&lt;i&gt;Заключение. &lt;/i&gt;&lt;/b&gt; Выработанные критерии суммарного объемного кровотока и индекса реактивности у больных с клиникой ВБН являются четким физиологическим основанием для определения показаний к выполнению реконструктивной операции на 1-м сегменте ПА. HTML

Cawthorne Cooksey Versus Habituation Training In Vertebro Basilar Insufficiency Patients

Cawthorne Cooksey Versus Habituation Training In Vertebro Basilar Insufficiency Patients

Are there any novel radiological diagnostic clues in magnetic resonance imaging for vertebrobasilar insufficiency?

The aim of the current study was to investigate whether signal intensities on magnetic resonance imaging (MRI) views and radiological findings on Doppler ultrasonography may have a diagnostic value for vertebrobasilar insufficiency (VBI). This case-control study was performed on demographic and radiologic data derived from 18 VBI patients and 58 healthy controls in the radiology department of a tertiary care center. The blood flow characteristics including peak systolic and end diastolic flow rates, resistance and pulsatility indices, mean velocities, flow rates, diameters and intensity pattern of vertebral arteries on cervical and cranial MRI sequences were noted. The association between blood flow characteristics and signal patterns on MRI views was investigated in VBI patients and controls. Blood flow and vessel diameter were significantly decreased in VBI patients compared to controls on both sides (P<0.001). In contrast, other parameters did not exhibit any remarkable difference between VBI and control groups. The distribution of hypo- or hyperintense signals in VBI and control groups was similar. No remarkable variabilities were detected in blood flow characteristics of cases presenting with signals having different intensities on MRI sequences. In conclusion, results of the current study have demonstrated that assessment of blood flow and vascular diameter may be important for ruling in VBI. Nevertheless, the intensity of signals derived from vessels seems not reveal any data of diagnostic significance in these cases. Further studies on larger populations may allow development and exploration of newer diagnostic techniques and clues for VBI.

Effect of Collar on Balance in Vertebrobasilar Insufficiency Patients

Purpose of Study: The purpose of the study is to assess the effect of wearing collar on balance response and to determine whether hard collar or soft collar shows improvement in balance in patients suffering from Vertebrobasilar Insufficiency (VBI). The study is clinically significant to help determine type of cervical collar to be prescribed in patients suffering from VBI with balance problems. Methodology: 40 subjects were included after screening for vertebrobasilar insufficiency and were assigned into two groups with 20 subjects in each group. Group A was given Philadelphia collar and Group B was given soft collar. Balance response before and after wearing collar was analysed using Berg Balance Scale. Data analyses and result: Mann Whitney U test was used for analyses of data. Data of pre post Berg Balance score of soft collar and hard collar was measured by Wilcox- on signed rank test. Conclusion: soft collar is more effective then hard collar in improving balance of patients suffering from VBI.

Low scores on the Benton Facial Recognition Test associated with vertebrobasilar insufficiency

BackgroundDecreased posterior cerebral circulation has been observed in patients with vertebrobasilar insufficiency (VBI). Reduced cerebral perfusion may have an impact on mental performance as measured by the Benton Facial Recognition Test (BFRT). We evaluated the usefulness of BFRT in identifying cognitive decline in patients with VBI by correlating test performance with total blood flow in the vertebrobasilar system and other variables such as educational level and gender. Materials and methodsThirty-three participants without dementia (mini-mental state examination; MMSE >27) and cranial magnetic resonance imaging abnormality, but with atherosclerotic risk factors were involved in the study. Nineteen subjects had a total vertebrobasilar flow volume less than 200ml/min (Group I), and 14 subjects had a flow volume more than 200ml/min (Group II). ResultsThe groups were similar in regard to gender, age, and educational level. BFRT results were 19.53±3.12 and 22.36±2.73 for Groups I and II, respectively (p=0.01). The educational level was the main factor affecting the BFRT score in Group I (p=0.04). DiscussionBFRT is clearly impaired in VBI as measured by Doppler ultrasound examination. We concluded that the test appears to adequately distinguish cognitive levels between VBI and other patients. Additionally, our results suggest that education is associated with BFRT results, and for normative purposes, gender consideration is unnecessary. Further studies are needed to investigate the association between VBI and memory dysfunction in early dementia.

Obervation on the effectiveness of nursing mode about health interview for patients with vbivertebrobasilar

Objective To explore the effectiveness of nursing mode about health interview for patients with vbi vertebrobasilar. Methods Fifty one cases of vertebrobasilar insufficiency patients were randomly divided into the observation group (25 eases) and the intervention group (26 cases). Both of two groups adopted conventional treatment and care of vertebrobasilar insufficiency. Intervention group was received health care and interview model in practice at the same time, that is to say: taking some measures to patients of vertebral artery insufficiency , such as to be admitted to the hospital reception, hospital information support, discharged from hospital and health behavior guidance and regular telephone follow-up after discharge. All in all, to implement the entire process seamless care. Both of groups were evaluated with Anxiety Self-appraising Scale (SAS) . Results After first three weeks of admission to hospital, SAS scores of the intervention group were significantly lower than that of control group (average P <0.01), while the health evaluation was also better in observation group. Conclusions If applying the interview to health care model on the patients of vertebrohasilar insufficiency , it is good to improve unhealthy psychology, disease-related knowledge and compliant behavior on vrtebrohasilar insufficiency. What' s more, it can lower the rate of relapse, improve the quality of life, reduce the burden on family and society and accelerate professional growth of nurses at the same time. Key words: Vrtebrobasilar insufficiency; Quality of life; Interview on health care model

Forty-six Cases of Vertebrobasilar Insufficiency Treated by Acupuncture plus Intravenous Infusion of Ligustrazine

To observe the therapeutic effect of acupuncture plus Ligustrazine on vertebrobasilar insufficiency (VBI) by transcranial Doppler (TCD) sonography. 86 VBI patients including 56 cases of low flow rate velocity type (LFVT) and 30 cases of high flow velocity type (HFVT) were randomly divided into Ligustrazine group (26 LFRT and 14 HFVT) and acupuncture plus Ligustrazine group (30 LFVT and 16 HFVT). The blood flow velocity (BFV) of vertebral artery (VA) and basilar artery (BA) in systole before and after treatment was measured with TCD and therapeutic effects were evaluated after 10 days' treatment in the two groups. In the acupuncture plus Ligustrazine group, the total effective rate was 93.3% and 88.5% in cases of LFVT and HFVT respectively, and BFV of VA and BA increased in LFVT patients while that in HFVT patients decreased significantly (P<0.05 or P<0.01). Owing to its dual regulation on blood flow of VA and BA, the therapeutic effect of acupuncture plus Ligustrazine was better than that of simple Ligustrazine.

Deafness associated with vertebrobasilar insufficiency

The incidence of auditory disturbances in vertebrobasilar insufficiency (VBI) is considered much rarer than vestibular disturbances, but no routine audiometric test results for VBI patients have been published. To determine the incidence of deafness associated with VBI and the sites predominantly involved in deafness, we studied 70 vertiginous patients with VBI using a routine audiological examination and magnetic resonance imaging (MRI). MRI detected a lacunar infarct involving the cochlear nuclei in one patient, but lacunae did not involve central auditory structures in the other patients. Twenty-five patients experienced tinnitus, deafness, or both, during vertigo episodes. Audiological examinations confirmed the development of unilateral deafness in 15 (21%) patients, involving the cochlea in 14 and cochlear nuclei in one. These findings indicate that hearing loss occurs in approximately one-fifth of VBI patients, much less frequently than vestibular disturbances, and that deafness associated with VBI mainly involves the cochlea.

Magnetic resonance angiography evaluation of basilar artery stenosis in patients with vertebrobasilar insufficiency.

To assess the usefulness of evaluating basilar arterial flow by magnetic resonance angiography (MRA), MRA results for patients with vertebrobasilar insufficiency (VBI) were compared with those for age-matched individuals with no vestibular disorders. The presence of stenosis in the basilar artery, its severity and the presence of complications associated with atherosclerosis in the two groups were statistically compared. Analyses revealed significant differences in the incidence of stenosis, its severity, and the incidence of complications between the two groups. These findings suggest that MRA is valuable for the estimation of vertebrobasilar hemodynamics. MRA evaluation of basilar artery stenosis appears to be suitable for identifying a high-risk group among VBI patients, since basilar artery stenosis can result in serious disabilities.

椎骨脳底動脈循環不全によるめまい症例の赤血球変形能

Hemorheological impairment is thought to be one of the pathological conditions of vertebro-basilar insufficiency (VBI). To determine the contribution of impaired red blood cell deformability (RCD), one of the important factors of hemorheological impairment, to the pathogenesis of VBI, RCD was measured and compared between a group of VBI patients (21 males, 42 females) and a group of control adults without vertigo (22 males, 23 females). Diagnosis of VBI was based on the Guidelines established by the Japan Society for Equilibrium Research. RCD was measured by the red blood cell (RBC) centrifugation method according to the criteria established by the International Committee for Standardization in Haematology. RCD was significantly decreased in the VBI group (p<0.01). Blood levels of total cholesterol and triglyceride in the VBI group were significantly higher than those in the control group (p<0.05). RCD was not correlated with RBC counts, Hb, Ht, MCV, MCHC, platelet count or total cholesterol or triglyceride level. Administration of dilazep dihydrochloride (300 mg/day for 8 weeks) to VBI patients induced significant (p<0.05) improvement in RCD and relieved vertiginous symptoms. Vertigo in VBI is considered to result from a combination of conditions involving microcirculation disorder induced by decreased RCD, decreased vertebral arterial blood flow due to high blood levels of total cholesterol and triglyceride, and rapid occurrence of right-left difference in blood flow by action stimulation.

Noninvasive evaluation of vertebrobasilar insufficiency.

The diagnosis of vertebrobasilar insufficiency (VBI) is a clinical challenge because its manifestations are subjective and difficult to quantify. We evaluate 61 patients with the clinical diagnosis of VBI and 30 control patients with other medical problems. We used duplex scanning to study the extracranial carotid, vertebral, and subclavian arteries, and a 2-MHz transcranial Doppler (TCD) to examine the intracranial vertebral and basilar arteries. Extracranial lesions were more common in VBI patients than among controls, including stenosis of the subclavian artery with and without subclavian-vertebral steal and stenosis of the vertebral artery. Intracranial abnormalities identified in the vertebrobasilar circulation included stenosis and occlusion of the intracranial vertebral artery and basilar artery steal. Overall, significant lesions were detected in 32.8% of VBI patients and 3.0% of controls (P less than 0.05). Systolic artery velocity (cm/sec) in the extracranial vertebral artery was higher in controls (65.9 +/- 23.3) than in VBI patients who had no evidence of vertebrobasilar steal (43.0 +/- 17.4, P less than 0.05). Patients with a steal mechanism had an intracranial vertebral artery systolic velocity of 90.0 +/- 38.9, compared with 53.0 +/- 15.0 in controls (2P less than 0.050). Intracranial vertebral artery systolic velocity was higher among VBI patients with significant carotid artery disease (greater than 50%, 76.7 +/- 28.8) than in those with less severe disease (less than 50%, 47.3 +/- 13.8, P less than 0.05). Evaluation and quantitation of the vertebrobasilar circulation using both intra- and extracranial noninvasive studies may afford further insight as to the pathophysiology of vertebrobasilar insufficiency and provide a readily available, direct, and simple method of initial and serial assessment of VBI patients.