- Vertbrobasilar insufficiency
Definitions
- TIA syndrome of the posterior circulation
- A good description of the anatomy of the vertebral arteries and basilar artery on wikipedia
Main features
- Sudden onset
- Usually over the age of 50
- Has cardiovascular risk factors
- Symptoms depend on the area of the brain that is affected, but patients can experience:
- Vertigo
- Visual field defects (diplopia, hemianopia)
- Auditory phenomena (sudden sensorineural hearing loss)
- Facial numbness or parenthesis
- Dysphagia, dysarthria, hoarseness
- Syncope (drop attacks)
- Hemisensory extremity symptoms
- Isolated vertigo symptom is unusual. It usually accompanies other neurological symptoms
Investigations
- Clinic test: **Random glucose**, ECG
- As per any other TIAs (Fasting lipid, fasting glucose, FBE, UEC, Holter, U/S Carotid)
- MRA for a good image of the posterior fossa or if not available, CTA
Management
- Refer for hospital admission if happens acutely for better outcome
- Otherwise
- organise urgent CTB to exclude other pathology
- if no intracranial haemorrhage, start aspirin
- start anti hypertensive and statin
- organise ECG, blood test, holter monitor and carotid ultrasound. (ideally within 24 hrs)
- refer to neurologist for a second opinion
References:
- John Murtagh's general practice 5th edition
- Wikipedia
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