Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team

Vertebral artery Occlusion & stroke

  The occlusion of the vertebral artery  of back of neck due to various causes ranging from clots to compressions from other adjacent structures may lead to stroke.

 Vertebral arteries

 Vertebral arteries are the two major blood vessels of back of neck which arise from subclavian arteries on either side of neck. Vertebral arteries move upward through the foramens of vertebrae along the side of neck coursing upward and both arteries merging within the skull to form the single, midline basilar artery. The vertebral arteries supply blood to the upper part of spinal cord, brainstem, cerebellum, and posterior part of brain. These arteries are the major arteries which supply 20% of the blood to brain and spinal cord [80% of blood is provided by carotid arteries].

    Occlusion of these arteries usually happens from clots formed by atherosclerotic plaques of fat. Occlusion of vertebral artery can cause decreased oxygen supply to brain and may produce symptoms of transient ischaemic attack [ TIA] or minor stroke.

Minor stroke may be presenting with symptoms such as dizziness, double vision, disturbance of speech, loss of balance etc.

  Vertebral artery occlusion commonly occurs in old people as a part of atherosclerotic processes happening within the arteries with ageing. However, some risk factors increase the risk for clots and occlusion.

Major risk factors for vertebral artery atherosclerotic plaque include:

·       Unhealthy diet rich in saturated fat and sugar.

·       Uncontrolled diabetes

·       Hypertension or high blood pressure

·       high cholesterol

·       Smoking

·       Sedentary life style & physical inactivity

   Vertebral artery occlusion produces transient ischaemic attack or minor stroke mostly if the occlusion is partial. Complete occlusion of vertebral arteries on both sides of neck may produce major stroke and it could be fatal.

Vertebral arteries may be occluded from various other causes also.

Vertebral artery compression- The artery may be compressed at any point along the course by bony structures of vertebrae.

Signs & symptoms of vertebral artery occlusion

In all people with occlusion of the artery symptoms may not be present for some time. However, there is a low risk of stroke. But in others symptoms usually present with minor stroke or major stroke.

Spinal cord infarction also can occur if blood perfusion is blocked to spine due to occlusion, although this happens rarely. Spinal cord infarction is a state in which lack of blood supply to a particular area of spine causes destruction of nerve cells of that area.This may cause paralysis of body parts concerned with the area  supplied by the  damaged  part of the cord .

The common symptoms include:

·       Dizziness

·       Double  vision

·       Disturbance of speech

·       Loss of balance

·       Drop attacks

·       Loss of consciousness

·       Numbness

·       Nausea

Diagnosis of vertebral artery occlusion

If symptoms of vertebral artery occlusion is left undiagnosed and not appropriately managed it may result in strokes, heart attack or in a condition called vertebro basilar insufficiency (VBI), and sudden death.

  Neck pain or headache is an important warning symptom in some patients along with dizziness, double vision.

In case of spinal cord infarction, which is rare, resulting from poor blood supply to cord may produce symptoms of paralysis in lower part of the body. Therefore it is very important to understand the possibility of stroke or spinal cord infarction when a person experiences these symptoms and there is urgency to consult a doctor in a well-equipped healthcare institution. Timely diagnosis and treatment is important to prevent major stroke and other complications of occlusion.

 Investigations

·  Duplex ultrasonography (DUS) is the most common and standardized test for the initial screening.

· Computed tomography angiography (CTA)

· Magnetic resonance angiography (MRA)

All these imaging studies or tests can detect vertebral artery occlusion. Each test has its own advantages and disadvantages in visualizing the occlusion. Depending on the nature of symptoms and signs of the condition, history of diseases the appropriate investigations or  tests are chosen [Read more]

Treatment for vertebral artery occlusion

It is important to address the causes leading to occlusion to choose a treatment plan. Appropriate treatment is chosen after case history taking, clinical examination of the patient and evaluating the reports[findings] of all investigations performed.

·       Vertebral artery occlusion resulting from atherosclerosis or mechanical compression of the vertebral artery are treated with  antiplatelet medications such as aspirin, aspirin with modified-release dipyridamole, clopidogrel , or ticlopidine to prevent strokes, myocardial infarctions, and transient ischemic attacks.

·       Surgical revascularization of the vertebral artery or operation is done in cases of  occlusions caused by compression of the vertebral artery by bony structures. Decompression  of the vertebral artery, or endovascular treatment is performed.

How can you prevent the occlusion of vertebral arteries &their complications?

In order to prevent vertebral artery  occlusion it is very important to modify the risk factors leading to it.

Adopt a healthy life style, Avoid smoking.

 Promote physical activity.

Manage neck vertebral bone & disc diseases at the right time in the most appropriate way.

Manage diabetes, hypertension, high cholesterol.

Dietary modifications

Include more greens, reduce carbohydrates and saturated fat.

For further details on appropriate dietary pattern in accordance wit risk factors  you may have, please follow the link  given below:

http://siahmsrwellness.in/lifestyle-beauty/list/diets-lifestyle-diseases

copyright of all articles in siahmsrwellness.in  to  dr sanjana vb

References for further reading
1.      https://www.ncbi.nlm.nih.gov/books/NBK540995/  
2.      https://www.physio-pedia.com/Vertebral_Artery  
3.      https://pubmed.ncbi.nlm.nih.gov/15981730/  
4.      https://pubmed.ncbi.nlm.nih.gov/12509646/  
5.      https://pubmed.ncbi.nlm.nih.gov/9660392/  
6.      https://pubmed.ncbi.nlm.nih.gov/28722857/  
7.      https://pubmed.ncbi.nlm.nih.gov/24548843/  
8.      https://pubmed.ncbi.nlm.nih.gov/33552342/  
9.      https://pubmed.ncbi.nlm.nih.gov/21852605/  
10.    https://pubmed.ncbi.nlm.nih.gov/9660392/  
11.    https://pubmed.ncbi.nlm.nih.gov/15981730/
12.    https://pubmed.ncbi.nlm.nih.gov/17287234/  
13.    https://pubmed.ncbi.nlm.nih.gov/12509646/