Patients who experience vertebrobasilar insufficiency have poor blood circulation in the basilar artery in the back (posterior) section of the brain. In that region, two vertebral arteries join to become the basilar artery, and blockage of any of the arteries can occur over time through the build-up of plaque, a process called atherosclerosis.
In cases of vertebrobasilar insufficiency, it is suspected that a degenerative disc may have a significant increase in inflammatory cytokines, possibly irritating the sympathetic nerves that innervate cervical discs and cause vertebral artery insufficiency. Theoretically, this subsequently induces ischemia of the vestibular-cochlear organ.
Symptoms of Vertebrobasilar Insufficiency
Patients with vertebrobasilar insufficiency often experience neck pain, vertigo, and tinnitus, though vertigo is the most common complaint. Other symptoms may include double vision, loss of coordination, confusion or dizziness, loss of vision in part or all of both eyes, numbness or tingling, slurred speech, nausea and vomiting, trouble swallowing, or a sudden generalized weakness.
Many of these symptoms may be warning signs of a stroke, so even those with a history of poor cerebral circulation should seek emergency medical care if they experience them. Immediate action can improve treatment efficacy, though symptoms may be intermittent or permanent.
Vertigo is a symptom of vertebrobasilar insufficiency and other conditions of the brain and inner ear. Those experiencing vertigo feel unbalanced; pulled in one direction; or that they or the environment around them are continuously swaying, tilting, moving, or spinning. Depending on the severity of the condition, vertigo may be barely noticeable or debilitatingly severe. Some experience vertigo so dramatically that they cannot perform daily tasks.
Vertigo symptoms generally come in waves or bursts called attacks. They often come on suddenly and last for a few seconds, but some last much longer. Depending on the underlying condition, symptoms may be constant for several days. Subsequent symptoms of vertigo include loss of balance, dizziness, feeling sick or nauseated, headaches, and jerking or abnormal eye movements.
In addition to vertebrobasilar insufficiency, vertigo has a list of other causes:
- Meniere’s disease, an inner ear disorder allegedly caused by fluid buildup and changing pressure in the ear
- Vestibular neuritis, inflammation of the vestibular nerve (which connects the inner ear and the brain), causing both vertigo and hearing loss
- Labyrinthitis, infection of the inner ear
- Head or neck injury, while a less common cause of vertigo, can still inspire dizzy spells
Patients with tinnitus hear a ringing sound without an identifiable external cause. The phantom sound experienced is usually described as a ringing, but it can also manifest as more of a hissing, buzzing, clicking, humming, whooshing, or even roaring. It can affect both ears or just one and is a relatively common problem, found in 15% to 20% of the population.
Tinnitus is especially common in older adults, perhaps because there are connections to age-related hearing loss. Conditions such as vertebrobasilar insufficiency and Meniere’s disease can cause tinnitus, as can injuries to the head or neck, ear infections, ear canal blockage, blood vessel disorders, problems with the TMJ, or even medication. The condition may develop after an upper respiratory infection. If such is the case, see your physician if the ringing hasn’t cleared up within a week.
Treatment for Vertebrobasilar Insufficiency
As mentioned above, spinal aberrations may be responsible for some cases of vertebrobasilar insufficiency, though more definite pathology is not known. Known risk factors include high cholesterol and smoking, so those at risk should avoid smoking and make a concerted effort to maintain reasonable cholesterol levels. Medication may also help keep cholesterol at healthy levels.
Age and gender also play a role in developing the condition: men are more susceptible before age 75 while women have a higher risk afterward. These risk factors are clearly not treatable, and sometimes surgery may be required to improve blood flow through the brain.
In a study published in January 2015, a woman with vertebrobasilar insufficiency and associated episodes of tinnitus and vertigo found relief through disc surgery. Though she had suffered from the condition for 24 years, almost half her life, surgical correction of a small protruded disc at C5-C6 resolved all of her symptoms. The link between cervical disc pathology and vertebrobasilar insufficiency, as mediated by sympathetic nerves, seems clear. This is encouraging as it indicates that correction of spinal alignments and cervical lordosis will result in correcting insufficient blood supply to posterior cerebral circulation.