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Vertebrobasilar insufficiency (VBI) is caused by transient ischemia in the brainstem including the vestibular nucleus due to impaired vertebrobasilar arterial flow. The most common causes of VBI are atherosclerosis, which can block posterior circulation supplying the brain stem, and embolisms which arise from the heart and proximal vertebral and basilar arteries due to arrhythmia, as well as hemodynamic disorders associated with changes in blood pressure.
VBI is frequently associated with vertigo and disequilibrium as primary symptoms accompanied by neurologic symptoms and signs involving double vision, loss of vision, gait ataxia, face and limb numbness, weakness, dysarthria and oropharyngeal dysfunction. Posterior circulation strokes may induce fluctuating symptoms and signs with time depending on which area is ischemic.
It is crucial to examine the pathological condition of the vessels in the vertebrobasilar system to evaluate blood flow hemodynamics and vascular morphology in patients experiencing episodes of VBI with Doppler ultrasonography and a vascular imaging technique such as (Magnetic Resonance) MR and (Computed Tomography) CT angiography. Cerebrovascular circulation and metabolism-improving agents, antiplatelet agents, etc., are usually used to treat VBI.
VBI should be considered during the differential diagnosis of patients with recurrent vertigo and require an early detection. Therefore, VBI might require careful follow-up and treatment for preventing the progression of vertigo and other neurological deficits in the vertebrobasilar arterial region.
