Syndrome of the vertebral artery: symptoms and treatment

Syndrome of the vertebral artery (SPA) is a complex of symptoms arising from the violation of blood flow in the vertebral (or vertebral) arteries. In recent decades, this pathology has become quite widespread, which is probably associated with an increase the number of office workers and people leading a sedentary lifestyle, spending a lot of time at the computer. If earlier the diagnosis of SPA was exhibited mainly to elderly people, today the disease is diagnosed even in 20-year-old patients. Since any disease is easier to prevent than treat, it is important for everyone to know what the reasons are for syndrome of the vertebral artery, what symptoms are manifested, and how this pathology is diagnosed. About this, as well as the principles of treatment of SPA, we will talk in our article.

Basics of anatomy and physiology

Blood enters the brain along four large arteries: the left and right common carotid and left and right vertebrates. It is worth noting that 70-85% of the blood flow through the carotid artery, therefore, the violation of blood flow in them often leads to acute disorders of cerebral circulation, that is, to ischemic strokes.

Vertebral arteries provide the brain with blood only 15-30%. Infringement of a blood flow in them of acute, life-threatening problems, as a rule, does not cause - there are chronic violations, which, nevertheless, significantly reduce the quality of life of the patient and even lead to disability.

The vertebral artery is a pair formation, originating from the subclavian artery, which in turn departs to the left - from the aorta, and to the right - from the brachiocephalic trunk. The vertebral artery goes up and slightly back, passing behind the common carotid artery, enters the opening of the transverse process of the sixth cervical vertebra, rises vertically through similar holes of all overlying vertebrae, through the large occipital foramen enters the cavity of the skull and follows the brain, supplying blood to the posterior parts of the brain: cerebellum, hypothalamus, corpus callosum, midbrain, partially - temporal, parietal, occipital lobe, and also a dura mater of the posterior cranial fossa. Before entering the cavity of the skull from the vertebral artery, branches that carry blood to the spinal cord and its membranes depart. Consequently, when there is a disturbance in the blood flow in the vertebral artery, there are symptoms that indicate hypoxia (oxygen starvation) of the brain areas that it feeds.

The causes and mechanisms of development of the vertebral artery syndrome

On its length, the vertebral artery contacts both the solid structures of the spinal column and the soft tissues surrounding it. Pathological changes that occur in these tissues are prerequisites for the development of SPA. In addition, the cause can be congenital features and acquired diseases directly arteries.

So, there are 3 groups of causative factors of the vertebral artery syndrome:

1. Congenital peculiarities of the structure of the artery: pathological tortuosity, path anomalies, kinks.
2. Diseases that result in reduced arterial clearance: atherosclerosis, all kinds of arteritis (inflammation of the walls of the arteries), thrombosis and embolism.
3. Arterial compression from the outside: osteochondrosis of the cervical spine, bone structure anomalies, trauma, scoliosis (this is vertebrogenic, that is, related to the spine, causes), as well as tumors of the neck tissues, their cicatrical changes, spasm of the neck muscles (these are non-cause-causing causes).

Often, a spa occurs due to several causative factors.

It is worth noting that the spa is developing on the left most often, which is explained by the anatomical features of the left vertebral arteries: it departs from the arch of the aorta, in which there are often atherosclerotic changes. The second leading cause, along with atherosclerosis, are degenerative-dystrophic diseases, that is, osteochondrosis. The bony canal in which the artery passes is sufficiently narrow, and at the same time mobile. If there are osteophytes in the region of the transverse vertebrae, they squeeze the vessel, disrupting the flow of blood to the brain.

In the presence of one or more of the above reasons, the factors predisposing to the deterioration of the patient's health and the appearance of complaints are sharp turns or inclinations of the head.

Symptoms of the vertebral artery syndrome

Patients with spinal artery syndrome are often concerned about dizziness and headache.

The pathological process with the SPA passes through 2 stages: functional disorders, either dystonic or organic (ischemic).

The stage of functional disorders (dystonic)

The main symptom at this stage is a headache: a constant, aggravated during head movements or with prolonged forced position, baking, aching or pulsating nature, covering the nape of the neck, temples and the next forward to the forehead.

Also at the dystonic stage, patients complain of varying degrees of dizziness: from a sense of mild instability to a feeling of rapid rotation, tilt, and fall of one's own body. In addition to dizziness, patients are often disturbed by tinnitus and hearing impairment.

There may be a variety of visual disturbances: sand, sparks, flashes, darkening in the eyes, and when examining the fundus, the tonus of its vessels decreases.

If at the dystonic stage the causative factor is not eliminated for a long time, the disease progresses, the next, ischemic stage occurs.

Ischemic, or organic, stage

At this stage, the patient is diagnosed with transient disorders of cerebral circulation: transient ischemic attacks. They are sudden seizures of marked dizziness, impaired coordination of movements, nausea and vomiting, speech disorders. As mentioned above, these symptoms are often provoked by a sharp turn or tilt of the head. If the patient takes a horizontal position under similar symptoms, the probability of their regression (disappearance) is high. After an attack, the patient feels broken, weak, tinnitus, sparks or flashes before his eyes, headache.

Clinical variants of vertebral artery syndrome

These are:

• drop-attack (the patient suddenly falls, his head throws back, he can not move and stand up at the moment of the attack, the consciousness is not broken, for several minutes the motor function is restored; this condition occurs due to insufficient blood supply to the cerebellum and tail sections of the brain stem);
• syncopal vertebral syndrome, or Unterharnstein syndrome (with a sharp turn or inclination of the head, as well as in the case of a long stay in forced the patient's condition loses consciousness for a short time; the cause of this condition is ischemia of the region of the reticular formation of the brain);
• posterior-cervical sympathetic syndrome, or Bare-Lieu syndrome (the main feature of it are persistent intense headaches such as " helmet "- are localized in the occipital region and extend into the anterior parts of the head; pains after sleep on an inconvenient pillow intensify, when turning or the inclination of the head; character of pains pulsating or shooting; may be accompanied by other symptoms characteristic of the spa);
• vestibulo-atactic syndrome (the main symptoms in this case are dizziness, a sense of instability, imbalance, darkening in the eyes, nausea, vomiting, as well as violations of the cardiovascular system (shortness of breath, pain in the heart and others);
• basilar migraine (seizure preceded by visual impairment of both eyes, dizziness, gait unsteadiness, tinnitus and blur speech, after which there is an intense headache in the nape of the neck, vomiting, and then the patient loses consciousness);
• ophthalmic syndrome (on the foreground are complaints from the organ of vision: pain, a feeling of sand in the eyes, lacrimation, redness of the conjunctiva; patient sees flashes and sparks before your eyes; visual acuity decreases, which is especially noticeable with eye strain; partially or completely drop out the field of view);
• cochleo-vestibular syndrome (the patient complains of reduced hearing acuity (especially difficult perception of whisper speech), tinnitus, feeling shaking, instability of the body or rotation of objects around the patient; the nature of complaints varies - they directly depend on the position of the patient's body);
• syndrome of vegetative disorders (the patient is disturbed by the following symptoms: chills or a feeling of heat, sweating, constantly moist cold hands and feet, Stitching pains in the heart, headaches and so on; often this syndrome does not flow by itself, but is combined with one or more others);
• transient ischemic attacks, or TIA (the patient notes periodically arising transient sensory or motor disorders, impairment of vision and / or speech, shakiness and dizziness, nausea, vomiting, double vision, difficulty swallowing).

Diagnosis of vertebral artery syndrome

Based on the complaints of the patient, the doctor will determine the presence of one or more of the above syndromes and, depending on this, will assign additional methods of investigation:

• roentgenography of the cervical spine;
• magnetic resonance imaging or computed tomography of the cervical spine;
• duplex scanning of vertebral arteries;
• vertebral dopplerography with functional loads (flexion / extension / turn of the head).

If the diagnosis is confirmed during a pre-examination, the specialist will prescribe the appropriate treatment.

Treatment of vertebral artery syndrome

The effectiveness of treatment of this condition directly depends on the timeliness of its diagnosis: the earlier the diagnosis is made, the less thorny will be the path to recovery. Complex treatment of SPA should be carried out simultaneously in three directions:

• therapy of pathology of the cervical spine;
• restoration of the lumen of the vertebral artery;
• additional methods of treatment.

First of all, the patient will be prescribed anti-inflammatory and decongestants, namely, non-steroidal anti-inflammatory drugs drugs (meloxicam, nimesulide, celecoxib), angioprotectors (diosmin) and venotonics (troxerutin).

To improve blood flow through the vertebral artery, use agapurin, vinpocetine, cinnarizine, nicergoline, instenon and other similar drugs.

To improve the metabolism (metabolism) of neurons, use citicoline, gliatilin, cerebrolysin, actovegin, mexidol and pyracetam.

To improve metabolism, not only in the nerves, but also in other organs and tissues (vessels, muscles), the patient takes mildronate, trimetazidine or thiotriazoline.

To relax the spasms of the striated muscles, midolithium or tolpperil, smooth muscle vessels, drotaverin, better known to patients as No-shpa, will be used.

In migraine attacks, use antimigrenous drugs, such as sumatriptan.

To improve nutrition of nerve cells - vitamins of group B (Milgamma, Neurobion, Neurovitan and others).

To eliminate mechanical factors compressing the vertebral artery, a patient may be assigned physiotherapy (manual therapy, post-isometric muscle relaxation) or surgical intervention.

In the recovery period, massage of the collar zone, therapeutic exercises, acupuncture, and also sanatorium treatment are widely used.

Prevention of vertebral artery syndrome

The main preventive measures in this case are active lifestyles and healthy sleep on comfortable bedding (it is highly desirable that they belong to the category of orthopedic). In the event that your work involves a prolonged presence of the head and neck in one position (for example, work at a computer or activities related to with continuous writing), it is strongly recommended to take breaks in it, during which to conduct gymnastics for the cervical spine. If you have any of the complaints listed above, you should not wait for their progression: the right decision will be to consult a doctor in a short time. Do not be ill!