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vertebrobasilar disease
Etiology:
- cardiovascular disease, cerebrovascular disease
- chiropractic manipulation of the neck
Pathology:
- symptoms attributable to ischemia of:
- medulla, pons, midbrain, cerebellum, thalamus, occipital cortex [3]
- supplied by:
- posterior inferior cerebellar artery
- anterior inferior cerebellar artery
- superior cerebellar artery
- posterior cerebral artery [4]
Clinical manifestations:
1) dysarthria
2) disequilibrium, dizziness
3) ataxia
4) diplopia
5) visual field loss
6) perioral paresthesias
7) facial weakness
8) acute confusional state
9) profound general weakness
Management:
- also see internal carotid artery disease
- periprocedural stroke or death much higher for intracranial stenting than for extracranial stenting (16% vs 1%) [5]
- recurrent stroke similar for medically managed vs stented patients
- extracranial stenosis (11% vs 7%)
- intracranial stenosis (22% vs 22%) [5]
Related
carotid artery disease
vertebrobasilar stroke
vertebrobasilar system
General
arterial occlusive disease
cerebral ischemia
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 1021-22
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006
- Brott TG et al.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/
SVM/SVS guideline on the management of patients with
extracranial carotid and vertebral artery disease:
Executive summary. A report of the American College of
Cardiology Foundation/American Heart Association Task Force
on Practice Guidelines, and the American Stroke Association,
American Association of Neuroscience Nurses, American
Association of Neurological Surgeons, American College of
Radiology, American Society of Neuroradiology, Congress of
Neurological Surgeons, Society of Atherosclerosis Imaging
and Prevention, Society for Cardiovascular Angiography and
Interventions, Society of Interventional Radiology, Society
of NeuroInterventional Surgery, Society for Vascular Medicine,
and Society for Vascular Surgery. Developed in collaboration
with the American Academy of Neurology and Society of
Cardiovascular Computed Tomography.
J Am Coll Cardiol 2011 Feb 22; 57:1002.
PMID: 21288680
- Geriatric Review Syllabus, 9th edition (GRS9)
Medinal-Walpole A, Pacala JT, Porter JF (eds)
American Geriatrics Society, 2016
- Markus HS, Harshfield EL, Compter A et al.
Stenting for symptomatic vertebral artery stenosis:
A preplanned pooled individual patient data analysis.
Lancet Neurol 2019 Jul; 18:666-673
PMID: 31130429
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30149-8/fulltext