Vertebrobasilar insufficiency

Vertebrobasilar insufficiency
Classification and external resources
Specialty	neurology
ICD-10	G45.0
ICD-9-CM	435.3
DiseasesDB	29497
MedlinePlus	001423
eMedicine	emerg/834
MeSH	C10.228.140.300.150.956
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Vertebrobasilar insufficiency (VBI) or vertebral-basilar ischemia, also called beauty parlour syndrome (BPS), is a temporary set of symptoms due to decreased blood flow (ischemia) in the posterior circulation of the brain. The posterior circulation supplies blood to the medulla, cerebellum, pons, midbrain, thalamus, and occipital cortex (responsible for vision). Therefore, the symptoms due to VBI vary according to which portions of the brain experience significantly decreased blood flow (see image of brain [1]). In the United States, 25% of strokes and transient ischemic attacks occur in the vertebrobasilar distribution. These must be separated from strokes arising from the anterior circulation, which involves the carotid arteries.

Vertigo, the sensation of spinning even while a person is still, is the most recognizable and quite often the sole symptom of decreased blood flow in the vertebrobasilar distribution. The vertigo due to VBI can be brought on by head turning, which could occlude the contralateral vertebral artery and result in decreased blood flow to the brain if the contralateral artery is occluded. When the vertigo is accompanied by double vision (diplopia), graying of vision, and blurred vision, patients often go to the optometrist or ophthalmologist. If the VBI progresses, there may be weakness of the quadriceps and, to the patient, this is felt as a buckling of the knees. The patient may suddenly become weak at the knee and crumple (often referred to as a “drop attack”). Such a fall can lead to significant head and orthopedic injury, especially in the elderly.

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