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{{Vertebrobasilar insufficiency (patient information)}}

{{CMG}}; '''Assistant Editor(s)-in-Chief:''' Alexandra M. Palmer

==Overview==
[[Vertebrobasilar insufficiency]] refers to [[conditions]] in which [[blood]] supply to the back of the [[brain]] is disrupted.

==What are the symptoms of Vertebrobasilar insufficiency?==
*Difficulty keeping your balance
*[[Difficulty swallowing]]
*Difficulty walking
*[[Double vision]] or [[vision loss]]
*[[Headache]]
*[[Hearing loss]]
*[[Nausea]] and [[vomiting]]
*[[Neck]] ache
*[[Numbness]] or [[tingling]]
*[[Poor coordination]]
*[[Sleepiness]] or even apparent sleep from which the person can not be awakened
*Slurred speech
*[[Stroke (patient information)|Stroke]] or [[Transient ischemic attack (patient information)|transient ischemic attack]]
*[[Vertigo (patient information)|Vertigo]] (sensation of things spinning around)

==What causes Vertebrobasilar insufficiency?==
The [[vertebrobasilar system]] is also called the back ([[posterior]]) [[circulation]] of the [[brain]]. Three main [[blood vessels]] provide [[blood flow]] to the back of the [[brain]]:
*One [[basilar artery]]
*Two [[vertebral arteries]]

The back of the [[brain]] contains structures that are crucial for keeping a person alive. For instance, the [[brainstem]] controls [[breathing]] and [[swallowing]], among other things. Parts of the [[brain]] help with vision ([[occipital lobes]]) and movement coordination (cerebellus) are also located in the back of the [[brain]].

Many different conditions may cause [[blood flow]] in the back part of the [[brain]] to be reduced or stopped. The most common cause is a [[stroke]] due to hardening of the [[arteries]] ([[atherosclerosis]]).

Vertebrobasilar [[vascular disorders]] may also be caused if a tear ([[dissection]]) in an artery wall leads to the release of a [[clot]] that blocks [[blood flow]]. [[Dissection]] can be caused by clogged [[arteries]], [[conditions]] such as [[fibromuscular dysplasia]], or [[injuries]] such a car accident. It may even be caused by manipulations of the [[neck]] by a [[chiropractor]], or during [[massage]]. However, most of the time, no apparent cause of [[dissection]] can be identified. When vertebrobasilar [[disease]] is present in a younger person, [[dissection]] of one of the [[arteries]] is often the cause.

Other less common causes of vertebrobasilar [[vascular disorders]] include [[connective tissue diseases]] and [[vasculitis]].

==When to seek urgent medical care?==
Call 911 or your local emergency number, or get to the emergency room if you have any symptoms that may suggest a [[vertebrobasilar insufficiency]].

==Diagnosis==
Tests depend on the possible underlying cause, but may include:
*[[CT]] or [[MRI]] of the [[brain]]
*[[Computed tomography angiography]] ([[CTA]]), [[magnetic resonance angiography]] ([[MRA]]) or [[ultrasound]] to look at [[blood vessels]] in the [[brain]]
*[[Blood tests]], including [[blood clotting]] studies
*[[Echocardiogram]]
*[[Electrocardiogram]] ([[ECG]]) and [[Holter monitor]]
*[[Lumbar puncture]] ([[spinal tap]]) -- rarely needed
*[[X-rays]] of the [[arteries]] ([[angiogram]])

==Treatment options==
Sudden onset of vertebrobasilar symptoms is a [[medical emergency]] that requires immediate [[treatment]]. For [[treatment]] information, see:
*[[Transient ischemic attack (patient information)|Transient ischemic attack]]
*[[Stroke (patient information)|Stroke]]

Several possible [[treatments]] are available for treating symptoms due to off and on (intermittent) narrowing of the [[blood vessels]]. However, there is generally no good [[surgical]] [[treatment]] for patients who have narrowing of the vertebrobasilar arteries. [[Blood pressure]] may be permanently raised to make sure enough [[blood]] gets to that part of the [[brain]] or [[blood thinners]] may be used to make sure additional clots do not form.

==Where to find medical care for Vertebrobasilar insufficiency?==
[http://maps.google.com/maps?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|map+top+hospital+Vertebrobasilar insufficiency}}}}&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl Directions to Hospitals Treating Vertebrobasilar insufficiency]

==What to expect (Outlook/Prognosis)?==
The outlook depends in part on the underlying cause. [[Strokes]] are potentially life-threatening, and require urgent medical care. Age and the person's overall [[health]] are taken into consideration when determining one's outlook for recovery. A substantial recovery can be expected in younger patients who have no significant medical problems.

Recovery also depends on the area of the [[brain]] that has been affected. The outlook is very poor when the patient is in a [[coma]] or cannot move both arms and [[legs]].

==Possible complications==
[[Complications]] of [[vertebrobasilar insufficiency]] are [[stroke]] and its [[complications]]. The [[complications]] of [[stroke]] include:
*Respiratory ([[breathing]]) failure (which may require use of a machine to help the patient breathe)
*Lung problems (especially [[lung]] [[infections]])
*[[Heart attack (patient information)|Heart attack]]
*[[Dehydration]] and [[swallowing]] problems (sometimes leading to the placement of [[feeding tube|tubes]] in the [[stomach]] for artificial feeding)
*Problems with movement or [[sensation]], including [[paralysis]] and [[numbness]]
*Formation of clots in the legs

Patients may have [[visual loss]] in one [[eye]].

[[Complications]] caused by [[medications]] or [[surgery]] may also occur.

==Prevention==
General prevention of [[strokes]] caused commonly by [[atherosclerosis]] includes cessation of smoking, regular [[exercise]], [[blood pressure]] control, healthy [[diet]], and management of [[diabetes]]. Prevention of [[dissection]] includes avoidance of neck manipulation, and prevention of [[trauma]] to the [[neck]].

==Sources==
http://www.nlm.nih.gov/medlineplus/ency/article/001423.htm

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