Vertebrobasilar Insufficiency
Basics
Description
Description
- Vertebrobasilar (VB) vascular system feeds the posterior region of the brain, which includes the brainstem, cerebellum, and inner ear
- 2 vertebral arteries (VA) derive from subclavian arteries and give rise to the anterior spinal artery and then join to form the basilar artery
- Arteries supplying the brainstem and cerebellum originate from the VB system before it branches into the 2 posterior cerebral arteries (PCA), such that a wide variety of focal neurologic deficits arise from VB circulatory dysfunction
- Vertebrobasilar insufficiency (VBI) results in inadequate perfusion of VB arterial circulation from thrombotic, embolic, or low-flow states
Etiology
Etiology
- Mechanism:
- Thrombosis:
- VB ischemia due to underlying VB atherosclerosis and clot formation
- Embolus:
- VB ischemia due to embolization of clot from proximal location
- Low-flow states:
- Hypoperfusion of VB system from systemic (e.g., cardiogenic shock) or localized (e.g., subclavian steal) reduction in blood flow
- Less common etiologies:
- Fibromuscular dysplasia
- Hypercoagulable states
- Thrombosis:
- Ischemic mechanisms causing VB insufficiency can herald and lead to VB territory infarcts
- Severe episodes of VB hypoperfusion or loss of circulation can lead to:
- “Locked-in” syndrome:
- Quadriplegia (eyelid or eye movement only) with intact consciousness
- “Top-of-basilar” syndrome:
- Pontine and cerebellar dysfunction with diminished level of consciousness
- “Locked-in” syndrome:
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Citation
Schaider, Jeffrey J., et al., editors. "Vertebrobasilar Insufficiency." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307061/all/Vertebrobasilar_Insufficiency.
Vertebrobasilar Insufficiency. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307061/all/Vertebrobasilar_Insufficiency. Accessed December 14, 2024.
Vertebrobasilar Insufficiency. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307061/all/Vertebrobasilar_Insufficiency
Vertebrobasilar Insufficiency [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 14]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307061/all/Vertebrobasilar_Insufficiency.
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