Clinical Diagnosis of Vertebrobasilar Insufficiency: Resident's Case Problem

Abstract

Study Design: Resident's case problem. Background: Vertigo and visual disturbances are common symptoms associated with vertebrobasilar insufficiency (VBI), but the physical examination procedures to verify the existence of VBI have not been validated in the literature. The objective of this resident's case problem is to demonstrate how a patient's complaint of vertigo and visual disturbances, combined with positive clinical examination findings, can be a potential medical screening tool for VBI. Diagnosis: The patient in this report was initially referred to physical therapy for neck pain. However, the patient's chief concerns identified during the history were (1) vertigo, (2) visual disturbances, (3) headache, and (4) right shoulder region pain. Clinical VBI tests were performed, whereby the patient's vertigo and visual disturbances were reproduced with cervical spine extension. The patient was sent back to the referring physician to be evaluated for possible VBI. Diagnostic imaging tests were ordered. Carotid ultrasound revealed 80% to 90% stenosis in the proximal left internal carotid artery, and magnetic resonance angiography of the extracerebral vessels showed greater than 90% stenosis of the left internal carotid artery. Discussion: VBI may be present in patients with subjective reports of vertigo and visual disturbances that are reproduced with VBI physical examination procedures. J Orthop Sports Phys Ther 2005;35:645-650.

Relationship between the Duplex Doppler Ultrasound and a Questionnaire Screening for Positional Tolerance of the Cervical Spine in Subjects with Suspected Vascular Pathology: A Case Series Pilot Study

“…The VAT certainly fi ts this description and is commonly used in clinical practice as a screening test for VBI despite controversy surrounding this test [25][26] . Cote et al 20 measured vascular impedance on 42 subjects with Doppler ultrasonography while in the VAT position and determined the sensitivity and positive predictive values of the VAT to be zero.…”

“…Asavasopon et al 25 reported that patient symptoms consistent with VBI were produced while performing the VAT and the patient was referred for further diagnostic imaging. Results from both ultrasonography and MRA confi rmed 80% to 90% stenosis in the left internal carotid artery and the patient subsequently underwent an endarterectomy.…”

Vertebral artery testing and differential diagnosis in dizzy patients

“…Asavasopon et al, [54] reported a case of a 63-year-old female whose symptoms were consistent with VBI. The VAT was positive and the patient was referred to a physician for further diagnostic testing.…”

Physical Therapists Referring Patients to Physicians: A Review of Case Reports and Series

“…In some of these publications, multiple patients were described, providing a total of 71 individual patient cases for review. 1,[4][5][6][7][8][12][13][14][15][16]17,18,[20][21][22][23][24][25][26][27][28][29][30][31][32]34,35,[37][38][39]41,42,44,[46][47][48][49][50][51][52][53][54][55]58,[60][61][62][63][64][65][66][67][68][69][70]…”