Vertebrobasilar Insufficiency

What is vertebrobasilar insufficiency?

Vertebrobasilar insufficiency (VBI) is when blood flow to the back of your brain reduces or stops. VBI affects the parts of your brain that control balance and movement.

Many people with VBI have only minor health problems. But VBI puts you at higher risk for a stroke or transient ischemic attack (TIA, or mini stroke). This condition can also sometimes cause serious disability and death.

Healthcare providers often treat vertebrobasilar insufficiency with lifestyle changes and medications. You may need surgery if you continue having symptoms despite these interventions.

Are there different types of vertebrobasilar insufficiency?

Transient vertebrobasilar insufficiency is a rare form of VBI caused by turning or rotating your head. Healthcare providers also call this condition:

• Bow hunter syndrome.
• Head turning syncope.
• Rotational vertebrobasilar insufficiency.

Who might get vertebrobasilar insufficiency?

You’re at higher risk of VBI if you’re over age 50 and have:

• Coronary artery disease or peripheral artery disease (PAD).
• Diabetes.
• Family history of VBI.
• High blood pressure (hypertension) or high cholesterol.
• History of smoking.
• Obesity.
• Plaque buildup in your arteries (atherosclerosis).
• Raised levels of fats (lipids) in your blood (hyperlipidemia).

Heart conditions that can cause a blocked artery (cardioembolic conditions) also raise your risk of VBI. These conditions include:

• Atrial fibrillation (Afib).
• Blood clotting disorders.
• Infective endocarditis.
• Vertebral artery dissection.

Men have twice the risk of VBI when compared to women. Black Americans also have a higher risk than other ethnic groups.

How common is vertebrobasilar insufficiency?

As many as 25% of people over age 70 may have VBI.

What causes vertebrobasilar insufficiency?

A hardening of your arteries (atherosclerosis) commonly causes VBI. Atherosclerosis occurs when plaque formed from cholesterol and calcium builds up in your arteries. This plaque causes your arteries to narrow and reduces blood flow.

Other common VBI causes include:

• Penetrating artery disease (when small arteries in your brain become blocked).
• Pulmonary embolism.
• Vertebral artery dissection.

Less common causes of VBI include:

• Blood disorders (coagulopathies).
• Drug addiction.
• Fibromuscular dysplasia (FMD).
• Migraine headaches.

What are the symptoms of vertebrobasilar insufficiency?

Symptoms of VBI may include:

• Balance problems, such as dizziness and vertigo.
• Confusion (delirium).
• Difficulty swallowing (dysphagia).
• Diseases that affect movement and coordination (ataxia).
• Double vision or loss of vision.
• Fainting (syncope).
• Loss of balance.
• Nausea and vomiting.
• Numbness in part of your body.
• Slurred speech (dysarthria).
• Sudden weakness, where you fall to the ground (drop attacks).
• Urinary incontinence.

How is vertebrobasilar insufficiency diagnosed?

Your healthcare provider will ask you about your symptoms and give you a physical exam. They may suggest other tests, including:

• Imaging tests: A CT (computed tomography) scan or magnetic resonance imaging (MRI) takes pictures of the blood vessels at the back of your brain.
• Angiography: Your healthcare provider will use angiography to take X-ray pictures of your arteries.
• Computed tomography angiography (CTA) or magnetic resonance angiography (MRA): A CTA or MRA makes high-resolution, 3D pictures of your blood vessels.
• Echocardiogram: An echocardiogram (also called an echo) uses an ultrasound to assess sound waves, which create images of your heart’s chambers and valves. This test examines your heart’s pumping action.
• Electrocardiogram: An electrocardiogram (also called an ECG or EKG) measures the electrical activity of your heart.
• Holter monitor: A Holter monitor records your heart’s electrical activity for 24 to 48 hours while you do your daily activities.
• Prothrombin time (PT) and partial thromboplastin tine (PTT) blood tests: The PT test and PTT test measure the time it takes for your blood to clot.

How is vertebrobasilar insufficiency treated?

Your healthcare provider may suggest lifestyle changes to help reduce your VBI symptoms. These changes may include:

• Achieving a healthy weight.
• Controlling your cholesterol by changing your diet.
• Increasing exercise.
• Quitting smoking.

Your healthcare provider may also recommend medications to help manage health issues. These may include medications to control:

• Blood clots.
• Blood pressure.
• Cholesterol.
• Diabetes.

If lifestyle changes and medications don’t help your blood flow, your healthcare provider may suggest surgery. Surgery to treat VBI includes:

• Carotid endarterectomy, where your surgeon removes plaque from your carotid artery.
• Coronary angioplasty and stent, where your surgeon inserts a small balloon along with a small metal tube (stent) into an artery in your heart to open it up.
• Coronary artery bypass surgery, which replaces a damaged blood vessel in your heart with a healthy one.
• Vertebral artery reconstruction, which fixes damage to the arteries that carry blood to your brain.

How is transient vertebrobasilar insufficiency treated?

Healthcare providers may treat transient vertebrobasilar insufficiency with:

• A brace or collar.
• Medication.
• Surgery, including minimally invasive spine surgery.

How can I reduce my risk of vertebrobasilar insufficiency?

You can reduce your risk of vertebrobasilar insufficiency if you:

• Eat a healthy diet.
• Exercise regularly.
• Keep your cholesterol under control.
• Manage other health conditions such as high blood pressure and diabetes by following your healthcare providers’ instructions.
• Quit smoking.

What is the outlook if I have vertebrobasilar insufficiency?

The prognosis for VBI depends on:

• Severity of your brain function issues (neurological deficit).
• Whether you’ve had a stroke.
• Your age.
• Your other health issues.

Serious cases of VBI may lead to disability and death.

Are there long-term effects from vertebrobasilar insufficiency?

Most people with mild symptoms are able to manage symptoms with lifestyle changes and medication. If you have severe symptoms, you may need rehabilitation for months to years.

Problems that can result from VBI include:

• Blood clots in your legs, or deep vein thrombosis (DVT).
• Blood clots in your lungs (pulmonary embolism).
• Dehydration and swallowing problems.
• Difficulty breathing.
• Difficulty moving (paralysis or numbness).
• Gastritis.
• Heart attack (myocardial infarction).
• Lung infections.
• Pressure injuries (bedsores).
• Stroke or transient ischemic attack (TIA).
• Vision loss.

Does vertebrobasilar insufficiency return after treatment?

VBI has a recurrence rate of 10% to 15%.

How do I take care of myself with vertebrobasilar insufficiency?

You can take care of yourself by learning skills to aid in your recovery. You may need help with:

• Bladder and bowel training.
• Nutrition.
• Safety around your home.
• Teaching you how to perform day-to-day activities.

Types of therapy that can benefit you include:

• Occupational therapy.
• Physical therapy.
• Speech therapy.

You may also need help from a home care nurse who can check on your recovery.

A note from Cleveland Clinic

Vertebrobasilar insufficiency (VBI) occurs when blood flow to the back of your brain lessens or ends. This part of your brain controls movement and balance, so VBI can lead to difficulty swallowing, dizziness and numbness. Hardening of your arteries (atherosclerosis) usually causes VBI. Lifestyle changes and medications can often help control your symptoms. Your healthcare provider may suggest surgery if your symptoms continue. Occupational, physical and speech therapy can also help improve your day-to-day life.