Syndrome of the vertebral artery. Narrowing of the vessels of the cervical spine

What is vertebral artery syndrome and are there effective methods of treatment are interested in people who have been diagnosed with a similar diagnosis. The vertebral artery syndrome is a symptom that occurs as a result of impaired blood circulation in the brain due to pinching of the vertebral arteries.

Until recently, SPA was found only in older people. Now this pathology is diagnosed even in twenty-year-old youth. More often develops left-sided syndrome. This situation is due to the fact that the left artery departs from the aorta, and the right - from the subclavian artery.

As a result of degenerative-dystrophic changes in the spine, pinching of the vertebral artery and narrowing of its lumen are observed. As a result, the brain does not receive the required amount of nutrients and oxygen, which leads to the development of hypoxia - oxygen starvation.

The vertebral, or vertebral, arteries carry only 30% of the blood to the brain (they also supply the spinal cord), the main part of the nutrients and oxygen comes through the carotid arteries.

Therefore, in most cases, vertebral artery syndrome does not pose a serious threat to life, but it can still lead to many problems. It can cause vegetovascular dystonia, cerebral hypertension and disability.

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The reasons

A variety of factors can cause vertebral artery syndrome. They can be divided into 3 large groups:

• Congenital anomalies in the structure of the artery (kinks, severe tortuosity);
• Diseases leading to a decrease in the lumen in the artery (arthrosis, atherosclerosis, arthritis, Kimmerley anomaly, embolism, thrombosis);
• Compression of the artery due to the development of osteochondrosis, scoliosis, pathological bone structure, muscle spasms, the presence of tumors in the neck.

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According to another classification, the reasons are:

• Vertebrogenic (they are associated with the spine): intervertebral hernia, degenerative-dystrophic changes associated with osteochondrosis, proliferation of osteophytes caused by spondylosis, inflammatory processes in the facet joints, trauma to the vertebrae;
• Non-vertebrogenic (not associated with the spine): atherosclerosis, narrowing of the lumen of the vessels due to their hypoplasia (underdevelopment), excessive tortuosity of the vessels, spasms.

Sharp head movements (tilts and turns) and a sedentary lifestyle are capable of provoking the development of pathology. To cure the syndrome, it is necessary, first of all, to eliminate its cause.

Symptoms

The symptoms of vertebral artery syndrome may be similar to other illnesses. These include:

• Headache - usually one-sided, may be throbbing or burning, worse after walking, running, riding in public transport, sleeping on your back;
• Nausea and vomiting that does not alleviate the general condition;
• Violations or loss of consciousness;
• Facial numbness;
• Visual - sudden severe pain in the eyes, dryness, periodic appearance of "fog" or "flies", transient weakening of visual acuity;
• Auditory and vestibular disorders - periodic hearing loss, the appearance of tinnitus, dizziness, pulsations in the head;
• Signs of malfunctions in the work of the cardiovascular system: unstable blood pressure, angina attacks;
• Brain disorders, accompanied by imbalance, slurred speech, change in handwriting,.

Diagnostics

The effectiveness of therapy depends on timely diagnosis. Therefore, before treating the pathology, the patient is sent for a comprehensive examination. If vertebral artery syndrome is suspected, diagnosis includes:

• Studying the patient's complaints and medical history;
• neurological examination;
• X-ray of the cervical region - detects pathological changes in the atlanto-occipital joint;
• Duplex scanning of the arteries - shows anomalies in the vessels, finds out their patency;
• Angiography of the arteries - measures the speed of blood flow and the diameter of the vessels, reveals the location of pathologies;
• Dopplerography - determines the violation of blood flow, examines the patency of blood vessels, the nature of blood flow and its speed;
• Magnetic resonance or computed tomography of the cervical region - reveals anomalies in the spine;
• Magnetic resonance imaging of the brain - evaluates the supply of brain cells with oxygen and nutrients, determines the cause of circulatory disorders, shows the localization of pinching.

Therapeutic methods are selected for each patient individually based on the results of a diagnostic examination.

Treatment Methods

If vertebral artery syndrome is diagnosed, treatment should be comprehensive. It is aimed at eliminating pathologies in the cervical spine and normalizing the lumen of the artery.

Treatment includes:

• drug therapy;
• Physiotherapy;
• Acupuncture;
• manual therapy;
• Therapeutic exercise;
• Orthopedic treatment;
• Spa treatment;
• Surgery.

conservative methods

When drug therapy of the syndrome is used:

• Non-steroidal anti-inflammatory drugs (nimesulide, aceclofenac, ibuprom, meloxicam, celebrex, celecoxib) - relieve pain, relieve inflammation, prevent blood clots;
• Muscle relaxants (tolperisone, midokalm, baclofen, drotaverine, known as no-shpa) - relieve increased muscle tone, relieve convulsions;
• Vasoactivators (cinnarizine, agapurine, trental, nicergoline, cavinton, vinpocetine, instenon) - dilate arteries, activate blood circulation in the brain;
• Venotonics (troxerutin, diosmin) - improve venous outflow;
• Angioprotectors (diosmin) restore the efficiency of the arteries;
• Neuroprotectors (gliatilin, somazina, sermion) - protect the brain from adverse factors, prevent damage to neurons;
• Antihypoxants (mexidol, actovegin) - prevent the development of hypoxia by regulating energy metabolism;
• Nootropics (lucetam, piracetam, thiocetam) - improve brain function, cheer up;
• Medicines that restore metabolism in nerve cells (gliatilin, glycine, citicoline, piracetam, semax, cerebrolysin, mexidol, actovegin);
• Medicines that normalize metabolism throughout the body (thiotriazoline, trimetazidine, mildronate);
• Vitamins belonging to group B (milgamma, neurovitan, neurobion) - improve the nutrition of neurons.

If necessary, symptomatic treatment is prescribed:

• Antimigraine drugs (sumatriptan) - used for migraine attacks;
• Drugs that eliminate dizziness (betaserc, betahistine);
• Calming medications;
• Antidepressants.

Effectively complement drug therapy physiotherapy procedures:

• Traction (traction) of the spine;
• Magnetotherapy;
• Darsonvalization;
• Galvanization;
• Diadynamic currents;
• exposure to ultrasound;
• Use of impulse current;
• Phonophoresis;
• Electrophoresis.

Acupuncture relieves pain and relieves neurological disorders. Specially selected exercises will help strengthen the muscular corset. Swimming will have a beneficial effect on the state of the body.

Massage activates blood circulation, which helps to fill the brain with oxygen. But any manual procedures should be carried out by a specialist. Otherwise, massage can aggravate the situation, causing irreparable harm to the body. If it is not possible to contact a professional massage therapist, then at home you can use a roller massager.

Orthopedic treatment involves the use of special bedding. With osteochondrosis, wearing a Shants collar is recommended. To relieve pain, use woolen scarves, ointments containing snake and bee venom.

Attention should be paid to proper nutrition in order to provide the body with all the necessary vitamins and minerals. It is recommended to include currants, cranberries, chokeberries, sea buckthorn, prunes, nuts, beans, fresh juices in the diet. It is necessary to completely abandon alcoholic beverages, as they increase hypoxia.

Usually, the treatment of vertebral artery syndrome is performed on an outpatient basis. But in severe cases, hospitalization is necessary.

Surgery

When conservative methods are ineffective, and the lumen of the artery narrows to 2 millimeters, surgery is recommended.

In specialized centers of vertebrology and neurosurgery, operations on the arteries are performed using minimally invasive methods using an endoscope. In this case, it is enough to make a small incision, less than two centimeters, which reduces injury to the body, prevents damage to nearby organs, and shortens the rehabilitation period.

During surgery, pathological bone growths are removed, the pinched artery is cut out at the site of narrowing, and its plastic surgery is performed. The effectiveness of surgical treatment reaches 90%.

Prevention

In order not to have to treat vertebral artery syndrome, it is better to prevent the development of pathology. To do this, you should lead an active lifestyle, sleep on a comfortable bed (preferably on orthopedic mattresses and pillows). In professional activities that require the neck to be in one position (for example, working at a computer), it is recommended to periodically do exercises for the cervical region. If you experience unpleasant symptoms, you should immediately consult a doctor.

Hypoplasia of the vertebral artery: signs, treatment, consequences

Hypoplasia of the vertebral artery is most often a congenital defect, and can be either right-sided or left-sided. In the future, the disease leads to a violation of hemodynamics (circulation), which especially affects the posterior parts of the brain. Most often, this causes numerous dysfunctions in the work of the heart and circulatory system as a whole, the vestibular apparatus and other organs.

General information about hypoplasia

Full blood circulation in all parts of the brain is possible due to; it is formed from the right and left branches of the spinal arteries.

Under normal conditions, both the right and left vertebral arteries are equally developed. In the region of the subclavian artery towards the cranial cavity, they are divided into small vessels.

The term "hypoplasia" in medicine describes the underdevelopment of tissues or an organ; it can be both a congenital pathology and an acquired one.

Bilateral hypoplasia is much less common than right-sided or left-sided, although the latter case is already considered quite rare. But since the adaptive capabilities of the body are not unlimited, their depletion very quickly leads to the stage of decompensation and the need for surgical intervention.

Causes and consequences of the disease

How does hypoplasia develop?

The factors that influence the occurrence of hypoplasia affect the human body even in the womb, however, the same can be said about most diseases and birth defects.

It is believed that the following processes and phenomena can cause hypoplasia:

• Bruises and various injuries of the mother during pregnancy;
• The abuse of certain drugs, alcohol, nicotine, and narcotic substances when carrying a child, toxic chemical compounds can also have a similar effect;
• Infectious diseases of the expectant mother;
• Genetic predisposition to diseases of the circulatory system;

Hypoplasia of the vertebral arteries does not always develop due to the above situations, these cases only significantly increase the risk of pathologies in the development and functioning of the circulatory system. But sometimes, however, children with congenital hypoplasia are born in the absence of any of the listed reasons. So modern medical luminaries do not yet have a consensus on this matter, although there are many conflicting theories.

What threatens the occurrence of the disease in the future?

In some cases, the defect does not make itself felt until a certain period or even throughout life, since hemodynamic disorders are attributed to other diseases or simply poor health, if the symptoms are not particularly pronounced.

The narrowing of the opening of the artery at the site of its confluence with the bone canal during hypoplasia significantly impedes the flow of blood to the brain tissues. The consequences of hypoplasia, therefore, can be unpredictable, and in this case it is far from immediately possible to identify the real cause of multiple dysfunctions. However, some of them do not pose a serious threat to health, but they definitely worsen the quality of life. These include increased fatigue, periodic severe headaches, a decrease in visual acuity and hearing.

Symptoms and diagnosis of hypoplasia

Problem symptoms

The main characteristic of the disease is the variety of symptoms, which can vary significantly in each individual patient. This applies both to the intensity of pain sensations and to manifestations of underdevelopment of the vertebral arteries in general. In some cases, the patient learns about a possible diagnosis only when undergoing a routine medical examination, since the clinical picture is very blurred, and the symptoms of hypoplasia are very similar to the external manifestations of other diseases.

It is possible to talk about the presence of hypoplasia of the right or left arteries if the following signs are present:

1. Frequent causeless dizziness;
2. Headaches of varying intensity;
3. Distorted perception of the position of the body in space, which occurs suddenly;
4. Dysfunctions of the nervous system;
5. Violation or complete disappearance of sensitivity in certain areas (including limbs);
6. Frequent high blood pressure.

Nonspecific signs of hypoplasia are the result of circulatory disorders in the body, but it is quite difficult even for an experienced specialist to identify their true cause. These include dizziness accompanied by loss of consciousness, sudden disorientation in space due to incoordination, which can lead to a fall, and staggering when walking or changing body position.

Loss of coordination of movements is a rare, but rather unpleasant manifestation of hypoplasia. This usually looks like an unreasonable fall or collision with people or objects, and the person himself may experience sensations similar to those that appear after a long ride on a carousel.

Usually, the intensity and frequency of all signs of hypoplasia of the vertebral arteries increases with the aging of the body, since age-related phenomena include a decrease in the elasticity of small and large vessels and their clogging. Thus, the lumen in the arteries affected by hypoplasia is additionally reduced, and hemodynamics worsens.

Identification of the disease

If there are suspicions, it will be useful to make an appointment with a neurologist. Examination of the patient and existing complaints about well-being are the reason for a more thorough check than the initial examination. If during the examination the specialist detects anomalies in the cervical region, then most likely it is worth doing an ultrasound examination of the arteries of the spine.

The result of ultrasound is a confirmation or refutation of a possible diagnosis. The conditional norm is the diameter of the lumen from 3.6 to 3.8 mm; vasoconstriction up to 2 mm is considered the main diagnostic sign. As an additional examination, the doctor may also recommend a pass, which, using X-rays and certain contrast agents, allows you to accurately identify the condition of the blood vessels.

"Right" and "left" hypoplasia

Hypoplasia of the right vertebral artery

Most experts do not share the symptoms of right and left hypoplasia as specific when it comes to external manifestations of the disease.

A significant difference in symptoms is observed only in case of violation of some brain functions, since the branches of the subclavian artery feed its various departments. Thus, in different areas leads to different consequences. It is worth noting that the symptoms of hypoplasia of the right vertebral artery are almost always common.

In addition to the previously listed manifestations, this pathology of the development of the circulatory system can cause emotional disorders. Patients often experience unreasonable mood swings with a high polarity of mood swings. Weakness and lethargy often occur even without overload and stress as such, and a depressed state can last for several days in a row. Complaints of increased fatigue and drowsiness occur in almost every patient, as well as a severe headache. occurs both with hypoplasia of the right and left vertebral arteries.

Hypersensitivity or a complete loss of sensitivity in some parts of the body often indicates that the part of the brain responsible for a certain area suffers from poor blood flow. Sometimes this makes it possible to make the correct diagnosis or confirm the current one.

The main trouble in the pathology of the right vertebral artery are concomitant diseases, for which hypoplasia acts as a kind of catalyst for degenerative processes. One of these diseases is, which leads to additional circulatory disorders, since it significantly constricts blood vessels.

With hypoplasia of the right artery, a strong meteosensitivity may develop in the future, and sometimes there are problems with sleep.

The difference in the consequences of hypoplasia of the right and left vertebral arteries is explained by the fact that they feed different parts of the brain.

Hypoplasia of the left vertebral artery

Unlike the right one, hypoplasia of the left vertebral artery may not manifest itself immediately, but closer to adulthood, since the symptoms are associated with circulatory disorders.

Hemodynamic dysfunction manifests itself not only in the form of poor vascular patency and organ ischemia as a consequence, but also as stagnation of blood in others. This happens only after a sufficiently long period of time, since adaptation mechanisms can very effectively avoid problems in the work of the organism that develops due to a deterioration in blood flow for the time being. The clinical significance of symptoms increases with age-related changes in organs and tissues, and at the primary stages, special attention should be paid to some external manifestations.

Pain in the cervical spine is considered one of the most indicative signs of left artery hypoplasia, although in the absence of other symptoms it is impossible to make a correct diagnosis.

The appearance of connections between the branches of the main main vessels (vascular anastomoses) is a typical manifestation of the action of compensatory mechanisms in the underdevelopment of both vertebral arteries. The achieved effect is lost in case of deterioration of vascular patency due to concomitant diseases.

In the case of hypoplasia of the left artery, hypertension (increase in pressure) is a secondary disease, and, in fact, a mechanism for adapting the body to the existing state of affairs. Under high pressure, blood passes into the brain much more easily even through a hole of small diameter, since the lumen of the artery in the case of hypoplasia is much narrower.

Method of treatment of hypoplasia

Paradoxically, in certain cases, a person does not need treatment for vertebral artery hypoplasia, since the body's adaptive capabilities allow it to cope with hemodynamic disorders for a long time and prevent the appearance of clinical symptoms in principle, and the blood supply to the brain does not worsen.

But if the signs of the disease have already shown themselves, then you should not delay a visit to the doctor, since vivid symptoms almost always indicate quite serious health problems. Most often this happens due to, with constant high physical and emotional stress, as well as in case of failures in the work of compensatory mechanisms.

Atherosclerosis, as well as stenoses of vessels of a different nature, is one of the main causes of hypoplasia. Therefore, in order to get rid of health problems, treatment should be comprehensive and exclude phenomena that painfully constrict blood vessels.

In this case, hypoplasia should be treated as soon as possible in order to prevent a significant deterioration in well-being and, if possible, avoid surgery, although most often surgery (for example, and/or ) is the only alternative, as the disease becomes severe.

With a relatively early diagnosis, specialists still try to avoid surgical intervention in the patient's body with the help of drug therapy. Drugs and pressure lowering drugs are the mainstay of treatment, and are recommended as an adjuvant.

In addition to the above methods, modern medicine does not have other means, although some "alternative medicine centers" offer other procedures as therapy - acupuncture, massage, various gymnastic complexes. You should not unconditionally rely on the promises of people who most often do not even have a special education. If desired, and only after consultation with your doctor, you can combine both methods.

Video: stenosis of the mouth of the left vertebral artery. Angioplasty with stenting

Diseases of the cervical spine have now become widespread not only among the elderly and middle-aged, but also among young people. At the same time, the number of vertebrogenic vascular disorders of the brain is growing, which have become an urgent problem of modern medicine. And an important role in such a situation is played by stenosis of the vertebral artery.

General information

The blood supply to the brain is carried out from two main basins: carotid and vertebral (respectively, the carotid and vertebral arteries). The latter covers a quarter of the entire need for oxygen and nutrients - it vascularizes the following structures:

• brain stem.
• Cerebellum.
• Occipital lobes.
• An extensive part of the temporal lobes.
• Posterior hypothalamus.
• Spinal cord (segments C1–Th3).
• Inner ear.

The defeat of the vertebral artery in diseases of the cervical region is determined by its anatomical and topographic features. The vessel, together with the nerve of the same name, passes in the canal, which is formed by holes in the transverse processes of the vertebrae. The latter is not static, as it changes according to movements in the neck. In the vertebral artery itself, according to its location, several segments are distinguished:

• 1 - from the subclavian artery to the entrance to the canal.
• 2 – in the canal at the level of C2–C6 vertebrae.
• 3 - from the exit from the canal to the entrance to the cranial cavity.
• 4 - in the cranial cavity (intracranial).

In the canal, the artery borders behind on the uncovertebral articulations, and on the side, on the superior articular processes. After leaving it, the vessel bends twice: in the frontal and sagittal planes. It is in these places that a violation of blood flow through the vertebral artery often occurs.

The topographic and anatomical features of the vertebral artery make it vulnerable to the adverse effects of a number of external and internal factors that contribute to impaired blood flow through the vessel.

The reasons

The narrowing of the lumen of any vessel is provoked by several reasons. It is possible to compress the wall from the outside with pathological formations (bone fragments, tumor, hematoma, etc.), internal blockage by an atherosclerotic plaque, thrombus, embolus, and, finally, spasm of the own muscle membrane (most often reflex). In relation to the vertebral artery, it is customary to distinguish two main groups of factors:

• Vertebrogenic.
• Non-vertebrogenic.

The former cause external compression of the vascular wall and the adjacent nerve due to pathological changes in the cervical region. In this case, the pressing elements are:

• Bone growths (osteophytes).
• Herniated discs.
• Osteoarthritis (articular joints,).
• Instability of the vertebral segments.

Structural disorders in the spine affect not only the artery itself, but also the nerve fibers surrounding it, leading to reflex spasm. The factors of external compression can be safely attributed to the muscles of the neck - hypertrophied or spasmodic (anterior scalene, inferior oblique) - which often accompanies the pathology of the spinal column.

It should be noted that even under physiological conditions, the vertebral artery is subject to a change in its lumen during head movements, but normally, blood flow restriction is well compensated. And if, along with external compression, there are changes in the vessel itself, then the situation is aggravated many times, manifesting itself as clear hemodynamic disturbances in the vertebrobasilar basin. Factors unrelated to the condition of the spine include:

• Internal occlusion for thrombosis, atherosclerosis, arteritis, embolism.
• Vascular deformities: pathological tortuosity, additional loops, kinks, path anomalies.
• External compression by scars, adhesions, hematomas and other volumetric formations.

Thus, the causes of stenosis cover a wide range of pathologies, both local and systemic. Therefore, in the practice of a neurologist, vertebrologist and traumatologist, great importance is given to the differential diagnosis of the vertebral artery syndrome.

The narrowing of the vertebral artery in most cases is due to the pathology of the cervical region, but there are also non-vertebrogenic causes of stenosis.

Symptoms

Based on the functional load on the vertebral artery, it is easy to predict what manifestations of stenosis may be. Violation of blood flow through the vessel with the failure of compensatory mechanisms provokes hypoxic changes on the part of those structures that are fed from the vertebral part of the brain pool. Of course, everything depends on the severity of pathological changes, but it should be mentioned that hemodynamically significant stenosis corresponds to the overlap of the vascular lumen by 50% or more. Accordingly, the stronger the external compression or internal occlusion, the more significant the clinical picture.

The complex of neurological disorders that occur during stenosis is combined into a concept. In the early stages, it has a functional nature, i.e., it occurs only at the moment of provoking movements - a sharp tilt or turn of the head - as well as in the case of a prolonged forced position. This causes the following symptoms:

• Headache.
• cochleovestibular disorders.
• visual disturbances.
• Vegetative dysfunction.

Vertebrogenic pains have a burning, throbbing or aching character, they are paroxysmal intensified, spreading from the back of the head to the parietal-temporal and frontal zone. Cochleovestibular disorders include dizziness, unsteadiness, and unsteady gait. Visual impairment is manifested by darkening, flickering of “flies” or “zigzags” before the eyes (photopsies). This may be accompanied by autonomic reactions such as a feeling of heat, increased sweating, increased heart rate.

With persistent and severe stenosis, acute and transient disorders of cerebral circulation are observed, leading to the appearance of foci of ischemia. Transient attacks do not last more than 48 hours and are characterized by:

• Vertigo.
• Ataxia (coordination disorders).
• Nausea, vomiting.
• Speech disorders.

In addition, sensitive disturbances are possible in the form of numbness and crawling "goosebumps" around the mouth, in the region of the upper or lower extremities. As a rule, this symptom is unilateral in nature, appearing with the syndrome of the left or right vertebral artery.

If the stenosis is of vertebrogenic origin, then transient ischemic disorders can be detected during movements in the neck. So, patients often experience sudden falls with the preservation of consciousness (drop attacks) or fainting (syncope). After such an attack, general weakness, lethargy, headache, tinnitus, flickering of "flies" in the eyes, sweating are noted.

In vertebral artery syndrome, a combination of various clinical variants of hypoxic-ischemic disorders in the brain structures is observed.

Additional diagnostics

Vertebral artery syndrome requires careful differentiation from other conditions that have similar features. The polymorphism of the clinical picture makes it difficult to form a preliminary conclusion - there is a risk of both underdiagnosis and overdiagnosis. But along with this, the doctor necessarily focuses on the results of additional studies that allow to identify changes in the spine, the vessel itself or the surrounding soft tissues. These include:

• with functional load.
• Tomography (magnetic resonance, computer).
• Doppler ultrasound.

Only in the presence of all clinical and instrumental signs, one can safely assert about stenosis of the vertebral artery and count on its adequate treatment.

Treatment

To effectively treat vertebral artery syndrome, you need to know its cause. Based on the variety of pathological processes and mechanisms that contribute to stenosis, therapy is characterized by the breadth of impact using various methods and methods. But each case is, of course, individual, and the approach to the patient should be carried out through the prism of all the characteristics of the body, and not just taking into account the degree of narrowing.

Medical

Drugs are of great importance in the treatment of vertebral artery syndrome. The list of drugs used in such patients is quite impressive, since it is required to act not only on clinical symptoms or altered structures of the spine, but also on the vessel wall, blood flow in it and brain tissues susceptible to hypoxia. Therefore, such drugs are used:

• Non-steroidal anti-inflammatory (Xefocam, Larfix,).
• Muscle relaxants (Mydocalm).
• Decongestants (L-lysine aescinate).
• Vascular (Latren, Actovegin).
• Antispasmodics (No-shpa).
• Metabolic (Mexidol, Cytoflavin).
• Neuroprotectors (Cortexin).
• Venotonics (Detralex, Troxevasin).
• Chondroprotectors (Don, Artra).
• Vitamins (Milgamma,).

Severe pain syndrome can be stopped with the help of paravertebral blockades with Novocaine and glucocorticoids (Diprospan). Local forms of drugs (ointment, gel, cream) are also of some importance.

Drug treatment of vertebral artery syndrome is carried out in strict accordance with the recommendations of a specialist. You can not deviate from medical appointments, because the final effect depends on it.

Non-drug

Among the conservative measures used in patients with stenosis of the vertebral artery, non-drug agents are widely used. They act on the factors of external vessel compression, surrounding tissues, improve cerebral blood flow and have a general tonic effect. The following treatment methods are used:

• Physiotherapy.
• Gymnastics.
• Massage.
• Manual therapy.

It must be remembered that an active impact on the spine should be carried out only after the elimination of acute events, because otherwise the symptoms of the pathology will only worsen. This applies to physical therapy with post-isometric exercises, and manual therapy. You should wait until the full effect of the use of medicines is manifested.

Surgical

In order to completely eliminate the basis of the vertebrogenic syndrome, in many cases one has to turn to surgeons for help. Operatively, volumetric formations protruding into the spinal canal (osteophytes, hernias) are eliminated, thus decompressing the artery. Sometimes it is necessary to perform a resection of the sympathetic nerve plexus, and in case of internal blockage, vascular techniques are used to remove blood clots and plaques.

The effectiveness of treatment largely depends on the timely conduct of diagnostic measures. Regardless of the causes of stenosis - associated with the spine or non-vertebrogenic - the appearance of clinical symptoms should be a reason to consult a doctor. And the specialist will determine their origin and prescribe the appropriate therapy.

Article publication date: 06/11/2017

Article last updated: 12/21/2018

From this article you will learn: what is hypoplasia of the right vertebral artery, the causes of this pathology, its characteristic symptoms and methods of treatment.

The vertebral artery is a paired vessel that departs from the subclavian artery and, together with the carotid arteries, provides blood supply to the brain.

With vascular anomalies, prerequisites are created for a decrease in cerebral blood flow. This is exactly what happens with hypoplasia of the right vertebral artery, and what is it? Hypoplasia is the underdevelopment of an organ, the result of which is a decrease in its functionality. In the case of the vertebral artery, we are talking about hypoplasia when the vessel diameter is reduced to less than 2 mm. This type of anomaly is congenital in nature and is often a consequence of the pathology of pregnancy.

Symptoms often occur only in adulthood due to a deterioration in the elasticity of blood vessels and the addition of atherosclerosis. In such a situation, there may be a decrease in blood flow to certain parts of the brain. Up to a certain limit, the pathology of the blood supply can be compensated, but the body's defense mechanisms may be depleted or not work in emergency situations.

Differences from lesions of the left vertebral artery are usually absent. The only difference is that the right-sided vascular lesion occurs several times more often than the left-sided one - according to some observations, in a ratio of about 3 to 1.

It is difficult to give an unambiguous answer about the danger of the condition. Brain neurons are especially sensitive to malnutrition due to impaired blood supply. Therefore, hypoplasia of the arteries leading to the brain can lead to more serious consequences for the body compared to the underdevelopment of other vessels. The degree of danger depends on the severity of hypoplasia and related health problems (vascular diseases, pathology of the cervical spine, heart disease).

A complete cure of the disease is impossible, even after surgery, only temporary compensation of local blood flow can be achieved.

Neuropathologists are usually involved in the treatment of hypoplasia of the vertebral arteries. Only those patients in whom hypoplasia is manifested by certain symptoms of deterioration of cerebral circulation need medical attention. With a significant narrowing of the lumen of the vessel with severe symptoms of circulatory disorders, it is necessary to consult a vascular surgeon to decide on the need for surgery.

Causes of hypoplasia of the right vertebral artery

Underdevelopment of the vertebral vessels is often detected incidentally in adulthood during the examination. However, this pathology is congenital. Various health problems of a pregnant woman, injuries during gestation, and hereditary predisposition can lead to underdevelopment of blood vessels.

List of possible causes of vertebral artery hypoplasia:

1. Infections transferred during pregnancy: rubella, influenza, toxoplasmosis.
2. Bruising or trauma to the mother.
3. The use of alcohol, drugs during pregnancy, smoking, drug addiction.
4. Genetic features that increase the risk of the formation of defects in the circulatory system.

Pathology can be asymptomatic for a long time. With a slight severity of circulatory disorders and symptoms, the condition can be mistakenly attributed to other pathologies: osteochondrosis, vegetative-vascular dystonia.

Hypoplasia is considered one of the most common anomalies of the vertebral arteries. Data on the prevalence of hypoplasia among the population differ in different sources and range from 2.5 to 26.5% of cases. But it is known that hypoplasia of the vertebral artery on the right is much more common than on the left or on both sides at the same time. This is probably due to the anatomical features of the formation of vascular formations. The vessel on the right departs from the subclavian artery at an acute angle, on the left almost at a right angle, the diameter of the right artery is often less than the left, and its length is greater.

The asymptomatic course of the anomaly of the right vertebral artery indicates sufficient compensation of blood flow due to the existing connections (anastomoses) between the vessels and due to the developed network of collaterals - branches of other vessels that supply blood to the same areas as the vertebral artery. Ensuring a uniform blood flow to all parts of the brain is largely due to the presence of closed circulatory systems, when the arteries of different vascular pools merge with each other. These protective mechanisms often compensate for insufficient blood flow through the right vertebral artery for a long time. Therefore, clinical manifestations often occur gradually as age-related changes develop.

Symptoms of pathology

The symptoms of this disease are very diverse and can vary significantly in different patients.

Here are some groups of symptoms:

Characteristics of the manifestations of the disease:

• Pain in pathology can vary significantly in intensity and other characteristics.
• Often, patients feel a throbbing or shooting pain that spreads from the neck and back of the head to the temporo-frontal regions.
• The pains are aggravated by turning the head, at night and after waking up.
• Often, hypoplasia is manifested by dizziness, a feeling of disorientation, and a distortion in the perception of the position of the body in space. Such episodes are often associated with head tilts, sudden movements. They can lead to staggering or even falling.
• Sharp attacks of dizziness are sometimes accompanied by loss of consciousness, fainting.

In addition to the pain syndrome in pathology, the following disorders may occur:

• blurred vision, eye pain, double vision, a feeling of sand or flies;
• hearing loss, tinnitus, sensorineural hearing loss, vestibular disorders;
• problems from the cardiovascular system;
• mood volatility, depression;
• fatigue, weakness;
• sleep disturbance;
• weather sensitivity.

Arterial hypertension, angina attacks are not always a direct consequence of anomalies of the vertebral vessels. Usually, the combination of cardiac pathology with hypoplasia leads to an aggravation of the course of the disease. At the same time, reduced blood flow in the vertebrobasilar basin provokes episodes of myocardial ischemia and an increase in blood pressure.

Hypoplasia of the right vertebral artery increases the risk of cerebral stroke due to impaired blood flow in the vertebrobasilar system and due to damage to the vascular wall in the event of atherosclerosis.

Treatment Methods

In the case of vascular hypoplasia, a complete cure of the disease is impossible. Even after reconstructive surgery, only temporary compensation of local blood flow can be achieved.

Conservative therapy

Conservative treatment includes taking medications, physiotherapy methods, physiotherapy exercises, acupuncture. To improve the blood supply to the brain, several groups of drugs are used:

Of the physiotherapeutic methods can be used:

• diadynamic currents;
• magnetotherapy;
• electrophoresis with drugs that have a vasodilating, analgesic effect.

Surgery

Surgical intervention can be performed in an open way or using an endovascular method (through small holes, without large incisions).

To restore blood flow, use:

• Stenting, in which a stent is inserted into the narrowing of the vessel - a frame to expand the narrowed area. Such stents can be impregnated with drugs.
• Angioplasty, in which a balloon is inserted into the narrowing zone, which is pumped with air to expand the vessel. Angioplasty and stenting can complement each other.
• In severe situations, a more complex reconstructive operation is performed: removal of the deformed area and prosthetics using the patient's own vein.

Forecast

The prognosis for the pathology of hypoplasia of the right vertebral artery depends on the degree of underdevelopment, compensatory mechanisms of the body, and comorbidities. In the absence of symptoms of deterioration of cerebral blood flow or minimal manifestations of pathology, the prognosis can be considered conditionally favorable.

Hypoplasia is considered a predisposing factor in the development of stroke. According to statistics, 70% of transient cerebrovascular accidents and 30% of strokes are associated with impaired blood flow in the vertebrobasilar system. Therefore, the detection of an anomaly requires the adoption of active preventive measures, especially in the presence of other risk factors.

The presence of pronounced manifestations significantly worsens the prognosis. With insufficient effectiveness of conservative therapy, only surgical treatment can improve the situation. Good results are obtained when using the endovascular method, which can be carried out even in patients with a high "surgical risk".

Many ailments of the brain are explained by the insufficiently correct functioning of blood vessels, for example, their atherosclerotic lesions and other disorders. Therefore, the correction of such diseases is primarily aimed at determining the cause of their development, and its elimination. Scientists argue that full-fledged blood circulation throughout the human body directly depends on the functioning of the circle of Willis, located in the brain. It consists of a pair of branches of the vertebral arteries. The topic of our conversation today will be the narrowing of the left vertebral artery or right.

Stenosis or, in other words, narrowing of the vertebral artery causes severe cerebral symptoms, represented by severe pain in the left or right side of the head, loss of consciousness and convulsions. Therefore, with such a pathology, its timely diagnosis and adequate therapy play an extremely important role.

The narrowing of the artery in the spine can lead to irreversible changes in the brain tissues, because it is through these vessels that blood enters the brain, and, accordingly, all the nutrients. Therefore, with this kind of stenosis, hypoxia of the supplied areas occurs. There is evidence that about a fifth of the structures of the brain are fed from the vertebral arteries (left and right), which pass from the left and right sides through the holes in the transverse processes of the cervical vertebrae.

Manifestations

Narrowing of the right vertebral artery or the left can be manifested by a number of different symptoms. They can be represented by dyspeptic symptoms (nausea and vomiting), pain in the cervico-occipital part and peripheral pain, which doctors also classify as a symptom of removing the helmet. In some cases, this kind of stenosis makes itself felt by an increase in unpleasant symptoms when sleeping on a pillow. The patient may be disturbed by painful sensations of a shooting and pulsating nature that occur in response to external influences on the head, for example, when touched or when the wind blows.

Pain that occurs against the background of narrowing of the vertebral arteries is strong. When the left artery is narrowed, they are localized on the left side, and when the right artery is narrowed, respectively, on the right.

Quite often, the narrowing of such vessels is accompanied by the development of vestibular syndrome. This condition is manifested by staggering, instability and pronounced bouts of dizziness.

Even if the disease proceeds in an uncomplicated form, it can lead to a short-term loss of consciousness, for example, due to a sharp turn of the head, vibration or pressure on the neck. With such symptoms, the patient should not drive a vehicle.

Against the background of narrowing of the vertebral arteries, secondary pathologies can develop from the inner ear or brain. In this case, tinnitus, a feeling of nausea and a decrease in hearing acuity also join the clinical symptoms.

Also, stenosis of the vertebral vessels adversely affects visual acuity, causing a noticeable decrease in vision, frequent eye fatigue and pathology of the visual analyzer.

The reasons

The narrowing of the vertebral arteries in the vast majority of cases is the result of vascular atherosclerosis, in which cholesterol plaques are deposited on the walls of the arteries. Also, such a pathology can be explained by nerve spasm or external compression of the vertebrae. Sometimes it is caused by tumor formations and thromboembolism. In some cases, the cause of stenosis is the tortuosity of either one vertebral artery, or even both.

Treatment Methods

To correct the narrowing of the vertebral arteries, methods of conservative and surgical therapy can be used. Drug treatment may include the use of drugs to treat atherosclerosis, such as statins. Also used are agents that help normalize blood flow, medicines to correct fainting and dizziness, eliminate nausea and muscle spasms. In some cases, it becomes necessary to use anti-inflammatory drugs. The drugs of choice are often drugs represented by Trental, Actovegin, Vinpocetine, Ceraxon, Cinnarizine, Cerebrolysin, Thiocetam, etc.

In some cases, non-drug therapy, namely massage procedures or reflexology, gives an excellent effect. In addition, manual therapy techniques can be used. A remarkable result is given by various procedures to improve blood flow and eliminate spasms, performing gymnastics and post-isomeric relaxation.

Sometimes, in order to increase the passage of the artery, the narrowing is corrected only by surgical methods. So, to restore the full blood supply to the brain, doctors can perform endarterectomy - direct removal of the formed atherosclerotic plaque from the affected vessel. With tortuosity of the vertebral artery and with other pathologies, stenting or balloon angioplasty is also practiced. In this case, the affected vessel helps to maintain the physiological lumen of the vessel or form it.

Correction of the narrowing of the vertebral arteries is not always successful, especially if the disease has gone too far and led to the development of irreversible changes in the brain.