The circulatory system in the human body is quite complex - the body has a huge number of vessels of various lengths and sizes. For convenience, the entire system is divided into several circles. For example, the Circle of Willis ensures complete blood circulation in all parts of the human brain. Its structure also includes arteries that pass in a certain place through the spinal column. And with a number of disorders, a disease such as hypoplasia of the left/right vertebral artery can develop. What is it, is it treated and how to identify this pathology?
Hypoplasia of the left/right vertebral artery - what is it?
General information
What is vertebral artery hypoplasia?
Hypoplasia of the right vertebral artery and hypoplasia of the left vertebral artery are an abnormal decrease in the lumen of these arteries (approximately to a diameter of less than 2 mm).
But there is no single criterion for narrowing the diameter of the vessel, and a number of authors include a decrease in the diameter of the vessel of less than 3 mm as signs of VA hypoplasia. The right vertebral artery is a branch of the right subclavian artery, which arises from the brachiocephalic trunk, and the left one arises from the left subclavian artery, which originates from the aortic arch. Next, both vertebral arteries (VA) rise in the bone canal to the brain and merge in the cranial cavity, forming the basilar artery. The vertebral arteries supply 15–30% of blood to the structures of the brain stem, the temporal/occipital lobes, the cerebellum, the hypothalamic region, and segments of the spinal cord, that is, they play a significant role in ensuring blood flow to the brain structures. Below is a picture of hypoplasia of the right/left VA.
Hypoplasia is one of the most common pathologies of the vertebral arteries. Its occurrence in the population, according to various sources, varies widely between 2.34% and 26.5% and is predominantly congenital in nature. Hypoplasia of one of the arteries occurs predominantly; cases of bilateral hypoplasia of the VA are relatively rare. The main place of narrowing of the lumen of the vertebral arteries is the place of entry into the bone canal (in the cranial cavity), which leads to a significant decrease in blood flow mainly to the posterior parts of the brain with the gradual development of non-vertebrogenic PA syndrome .
Hypoplasia of the vertebral artery is a factor in a significant reduction in blood circulation in the vertebrobasilar region, which disrupts the hemodynamics of the brain as a whole, increasing the risk of developing ischemic stroke (acute cerebrovascular accident). The situation is sharply worsening against the backdrop of the development of cerebral atherosclerosis , which is extremely common in the population due to poor lifestyle and especially dietary habits.
Diagnostics
It is not easy to diagnose hypoplasia precisely because of the mild symptoms. The treatment of pathology is carried out by a neurologist, to whom you need to come for an appointment. Typically, treatment occurs after the first signs appear - it is better not to delay, since the brain is clearly experiencing problems with blood supply, otherwise there would be no symptoms.
Diagnostic features
First, the doctor interviews the patient, finds out what he is complaining about, and then examines the patient. Next, you will need to undergo a series of tests and undergo some studies in order to be able to make an accurate diagnosis.
Doctors use the following research methods to confirm the diagnosis.
- Ultrasound of the vessels of the neck and head . Thanks to such a study, it is possible to clarify the diameter of the artery and the intensity of blood flow. If the artery has a diameter of less than 2 mm, then this is already considered a pathology. The normal diameter of the artery of the spinal column is 3.6-3.8 mm.
- Computed tomography of the brain and neck . The study makes it possible to assess the condition of blood vessels through the use of a special contrast agent.
- Angiography . This is a study using x-rays and special contrast agents. Makes it possible to detect anomalies in the structure of blood vessels.
MRI image
Pathogenesis
Currently, hypoplasia of the vertebral arteries is considered as one of the manifestations (during the formation of the fetal vascular system) of undifferentiated connective tissue dysplasia. Also in the pathogenesis of clinical manifestations, the development of vasospastic reflex reactions caused by irritation of the sympathetic plexus of the vertebral arteries is of significant importance. The resulting flow of afferent impulses irritates the overlying centers of vascular-motor regulation, which is manifested by local/diffuse reactions that predominantly affect the vessels of the vertebrobasilar system.
Treatment
You can help in two ways:
- Conservative therapy. This treatment of vertebral artery hypoplasia involves the administration of drugs that improve blood properties, blood supply to the brain and metabolic processes in it. This does not cure the problem, but only protects the brain from critical ischemic changes. For these purposes, trental, actovegin, vinpocetine, ceraxon, cinnarizine, cerebrolysin, thiocetam, blood-thinning drugs are used;
- Surgery. It is associated with great difficulties and is used only if it is impossible to compensate for cerebral blood flow in other ways. Modern neurovascular surgeons perform endovascular surgery. Its essence lies in the introduction of a special dilator (stent) into the lumen of the narrowed vertebral artery. It increases the diameter of the pathological section of the artery, restoring normal blood flow. This intervention is performed similarly to the diagnostic procedure - angiography and can be carried out during its implementation.
Treatment of hypoplasia of the right vertebral artery does not always bring the desired results. It all depends on the length of the narrowed area and the presence of connections between different arterial vessels of the brain (circle of Velisius). If it is sufficiently developed, it can compensate for almost any circulatory disturbance.
Causes
Hypoplasia is predominantly congenital in nature, the development of which can be caused by both chromosomal mutations and factors with an adverse effect on the mother’s body during pregnancy. These factors include:
- Bruises/injuries during pregnancy .
- Infectious diseases that have a negative impact on the fetus, especially in the early stages of development ( influenza , rubella ).
- Bad habits (smoking, alcoholism, drug addiction).
- Prolonged contact with harmful substances (work in hazardous industries, toxic chemicals, radiation).
- Drug abuse.
Material and methods
The study included 1500 patients with complaints of headache (950 women and 550 men, average age 42 ± 7.4 years) who were treated in the departments of neurology and therapy of the Clinical Hospital. S.R. Mirotvortsev SSMU in the period from October 2013 to May 2021.
Triplex scanning of the brachiocephalic arteries (TS BCA) according to the standard method was carried out on a stationary expert-class device Philips HD11 XE with linear (3–12 MHz) and convex (2–5 MHz) sensors on the basis of the department of ultrasound and functional diagnostics.
The diameters of the PA in the 2nd segment were assessed. Blood flow indicators in hypoplastic VAs were analyzed in segments 1–2. A hypoplastic VA was considered to be less than 2.0 mm in diameter. A PA diameter in the range between 2.0 and 2.5 mm was considered small.
Symptoms
The initial signs of VA hypoplasia are nonspecific, and they can be mistaken for manifestations of encephalopathy , cervical osteochondrosis or vegetative-vascular dystonia . PA hypoplasia syndrome is clinically manifested by three groups of symptoms:
- A group of vertebral symptoms (pain in the cervical spine/occipital region).
- Local symptoms - pain in the vertebral artery/structures of the corresponding vertebral segment (during palpation) with pronounced irradiation to the head.
- Symptoms at a distance from the vascularization zone of the VA, as well as due to irritation of the sympathetic plexus of the vertebral artery (increased blood pressure, migraine -type pain , body instability when walking).
The specificity of the clinical manifestations of VA hypoplasia is determined by a number of factors: the localization/extension of the lesion, the functional state of the arterial-venous system of the brain - the presence of anastomoses, collaterals, the state of the vascular wall.
Standard patient complaints include frequent, severe headaches ; dizziness ; surges in blood pressure ; inability to concentrate; memory loss; increased weather sensitivity ; deterioration of vision/appearance of “spots” in the field of vision; unsteady gait, decreased performance; difficulty making sudden movements/turns.
The presence of neurological complaints is traditionally considered to be indirect signs of stenosis . The symptoms of left-sided and right-sided VA hypoplasia are generally similar, however, the pathology of the vertebral artery on the right is often localized higher (in the intracranial area), which causes a more rapid development of symptoms and their more pronounced manifestation (a sharp drop in vision, loss of consciousness, severe coordination disorder).
The left vertebral artery initially has a larger working diameter, so symptoms do not appear so sharply and later. With left-sided hypoplasia, the characteristic symptoms are sharp, throbbing occipital pain; shots to the head; pain on palpation of the 1st and 2nd vertebrae of the neck; feeling of sand/double vision; tinnitus/hearing impairment. With bilateral VA hypoplasia, due to the lack of a compensatory effect, symptoms develop quickly, and there is a high risk of developing serious complications.
Diagnostic methods
To study the movement of blood in the vertebral arteries, angiography with X-ray or tomographic control is used. It helps to determine the degree of narrowing of the vessel and determine treatment tactics. Shown:
- radiography of the cervical spine;
- Ultrasound of the vessels of the head and neck in duplex scanning mode;
- CT and MRI of the spine and brain;
- rheoencephalography with stress tests;
- consultations with an ophthalmologist and otolaryngologist.
Consequences and complications
In general, VA hypoplasia significantly impairs quality of life. The most serious complications of VA hypoplasia primarily include a high risk of cerebrovascular accident/ stroke , which is caused by a decrease in blood supply to brain structures. In addition, frequent complications of the pathology of the vertebral arteries include neurological symptoms: headaches ( migraine ), irritability, depression, severe fatigue, disorders of the autonomic nervous system, impaired auditory/visual function, weakened cognitive abilities, dementia, decreased ability to work, arterial thrombosis
Possible consequences
The danger of hypoplasia lies, first of all, in an increased risk of stroke due to the fact that the blood supply to the brain is deteriorated. If you believe the statistics, about 30% of strokes are associated with circulatory disorders in this area. The disease can cause problems with hearing, vision, and the functioning of the vestibular apparatus. But in general, the consequences of this pathology are completely unpredictable. In any case, the disease worsens the quality of life, but is not fatal in itself.
Stroke and its consequences
In fact, the prognosis in the presence of this disease will depend largely on how underdeveloped the affected artery is, what state the human body is in, the presence of a number of certain pathologies, etc. In general, the prognosis is considered conditionally favorable. But if there are certain risk factors, it is important to take a number of preventive measures. Sometimes you have to do surgery.
Forecast
The prognosis is determined by many factors, in particular, unilateral/bilateral VA pathology, since with unilateral VA hypoplasia, blood flow compensation mechanisms develop, the functional state of the arterial-venous system of the brain, and the condition of the vascular wall (in particular, the presence of atherosclerotic plaques). After surgical treatment and drug rehabilitation, in most cases the lumen of the vertebral arteries can be normalized, and neurological symptoms regress.
List of sources
- Shmidt E.V. Classification of vascular lesions of the brain and spinal cord // Journal. neuropathology and psychiatry named after. S.S. Korsakov. 1985. T. 85, No. 9. p. 1281-1288.
- Kurtusunov B. T. Variant anatomy of the vertebral arteries at the stages of human ontogenesis. Author's abstract. diss. Doctor of Medical Sciences Volgograd, 2011.
- Pizova N.V., Druzhinin D.S., Dmitriev A.N. Hypoplasia of the vertebral arteries and cerebrovascular accidents // Journal of Neurology and Psychiatry. 2010. No. 7. P. 56–58.
- Kometov A.V., Zhukova M.V. Variants of the structure of the vessels of the arterial circle of the cerebrum depending on the type of Kimmerle anomaly. Congress of Manual Therapists of Russia, 1st: Materials. M 1999; 32.
- Odinak M.M., Mikhailenko A.A., Ivanov Yu.S. and others. Vascular diseases of the brain. St. Petersburg: Hippocrates 1997.
How to live with hypoplasia?
Step 1. You need to stop eating low-quality or unhealthy foods.
Avoid harmful foods
Step 2. You need to eat only high-quality and natural products. First of all, it is important to remember that fats should be healthy. Otherwise, the circulatory system suffers greatly.
Eat quality foods
Step 3: It is recommended to eat as much fiber as possible. There is a lot of it in broccoli, rice, whole grain bread, etc.
Eat more fiber
Step 4: It is important to drink plenty of pure water or water with antioxidants, such as lemon.
Drink water with antioxidants
Step 5. It is recommended to evenly distribute work and rest time and be sure to introduce physical activity into your life.
Don't forget about physical activity
Athletic belt
Step 6. You should stop smoking.
Quit smoking
Step 7. It is necessary to protect yourself from stress and spend time having fun and in pleasant company as often as possible.