Dizziness, pain of varying degrees of intensity, ringing in the ears, impaired coordination of movements, including loss of consciousness – symptoms that can be due to the same problem, namely pressing on the vertebral arteries or reducing their flow, due to stenosis (formation of plaques, most often).
Vertebral artery syndrome is not an independent condition, it is a consequence of other diseases – which can affect both the spine or muscles, and ligaments around it, and it can also be a consequence of vascular pathology.
It can be observed in a number of different pathologies, in which there is a narrowing of the lumen of one or both vertebral (spinal) arteries. As a result, the blood supply to individual parts of the brain parenchyma is disturbed, which leads to deterioration of their work, sometimes to critical conditions and stroke.
The two vertebral arteries pass through the cervical part of the spine and merge into the basilar artery, after passing into the skull. The so-called nar. vertebrobasilar basin, which provides 15-30% of the blood supply to the brain, this is also the reason that a number of symptoms are present when the arteries are affected.
Causes related to spine problems are spondylosis, myofascial syndrome, and scoliosis, including spondylolisthesis. Most often, the spinal arteries are pressed in the area of the 5-6 cervical vertebra, because changes such as osteochondrosis, protrusions, disc herniations, and spondylosis are most often manifested there .
Not to be underestimated are the causes related to the artery itself – thrombosis, aneurysm, vasculitis. In the case of thrombosis, hemoconcentration is established, while in the case of vasculitis with autoimmune etiology, the antinuclear antibodies are positive, thus these tests allow a faster and more accurate diagnosis, on the basis of which the treatment begins.
Syndrome of compression of the vertebral and anterior spinal arteries must be distinguished from more serious disturbances in blood flow such as thrombosis or embolism. In them, the symptoms do not go away so quickly and do not depend on the position of the neck and head, unlike those related to the musculoskeletal system.
The initial stage of the condition is functional or dystonic – the emerging manifestations of blood circulation disorders consist mainly of the appearance of a burning headache, pain usually of a pulsating nature, dizziness, instability of the gait, and visual disturbances in the form of darkening before the eyes.
Most often, these symptoms are paroxysmal – they manifest themselves suddenly when the door is held in a forced position for a long time or during many sharp and sudden changes in the position of the head. If this is accompanied by strong and prolonged spasms of the arteries, the condition leads to the formation of persistent foci of cerebral ischemia, which in turn is a transition to the second stage – organic or ischemic, with permanent disturbances in the blood supply to the brain tissues, which leads to a strong headache, dizziness, nausea, and vomiting, as well as serious disorders of coordination, orientation in space, speech.
With stenosis of the spinal canal, especially with sudden changes in the position of the head, there may also be pressure on the artery for a short time (a few seconds) and disruption of the blood flow in it. As a result, a transient appearance of vertigo, nausea, double vision, coordination disorders (staggering), and speech disorders can occur, which can be misdiagnosed as transient ischemic attacks.
Visual impairments consist mainly in the appearance of photopic phenomena, increased eye fatigue and deterioration of visual clarity when reading, working on a computer. There are often signs of conjunctivitis, as well as loss of entire visual fields, especially in certain positions of the head.
In the beginning, conservative therapy is started, and surgical intervention is extremely rarely required – for example, in the case of tumor formations, which are the cause of pressure on the arteries.
From the medicines – non-steroidal anti-inflammatory drugs, myorelaxants are used in severe spasm of adjacent muscles, vasodilators. Physiotherapy plays a key role, the application of complexes with exercises to strengthen muscles, as well as manual therapies to improve tone and facial changes. From the manual therapies, osteopathy, Bowen therapy are suitable. Massage techniques can also be applied.
Hospitalization is only recommended for patients with frequent ischemic attacks, as in such cases there is a high risk of stroke.
References:
1. CA Foster, P. Jabbour; Barré-Lieou syndrome and the problem of the obsolete eponym, The Journal of Laryngology and Otology;
2. MV Tardov, AV Boldin, AN Razumov; Cervicogenic vertigo, Journal of Neurology.
