Vertigo: Analysis by Magnetic Resonance Imaging and Angiography

Abstract

The relationship of vascular disease of the vertebrobasilar artery system to isolated vertigo was examined by magnetic resonance imaging and angiography. Eighty-nine individuals complaining of vertigo were evaluated by standard otoneurologic investigations, and the data were correlated with the vascular patterns of the cervical region and posterior fossa. The age distribution extended from the fourth decade to the ninth decade; the peak occurrence was observed in the eighth. Approximately 85% of the group experienced numerous episodes of vestibular dysfunction from months to years before examination; the remaining segment was examined following the first episode due to severity or persistence of symptoms. The criteria for vascular abnormality proposed by the authors are based upon comparison with previous normal findings. Approximately 52% of the cohort demonstrated abnormal configurations or evidence of diminished flow within the vertebrobasilar artery system. Of this segment, a vertebral artery was most frequently abnormal, in 76%; the basilar artery was judged pathological in 32%, and combined disease of several arteries was evident in 20%.

Basilar Artery and Vertigo

“…22 This report, while illustrating some of the possible abnormalities of the hindbrain circulation, supports the concept that intrinsic vascular disease can produce a hypoperfusion state without MRI evidence of infarction and may initiate the vestibulocerebellar disorders characterized in these patients' abstracts.…”

Digital subtraction angiography abnormalities in sudden unilateral profound hearing loss

“…Similarly, from carotid artery studies, it is known that cerebrovascular symptoms can be attributed to tortuosity of the carotid artery [28]. Overall, a limited number of our patients (3/10; 30%) showed angiographic abnormalities, and this is a smaller proportion than those who complain of other neurotological symptoms, such as vertigo (76%) [13].…”

“…In the remaining six patients the VAs were of equal size. Welsh et al [13] suggested that tortuosity of the VA consisting of at least two bends or a diameter at least three times greater than that of the contralateral VA at a similar cervical level should be considered pathological; based on these criteria, tortuosity was encountered in two of our patients (Cases 4 and 5) and important asymmetry of the VAs in one (Case 6).…”

“…Laser Doppler flowmetry [11], MRI with gadolinium enhancement [12] and magnetic resonance angiography (MRA) [13] have been used in patients suffering from labyrinthine symptoms to assess the blood flow through the vertebrobasilar (VBA) and inner ear systems. To our knowledge, digital subtraction angiography (DSA) has not been used to date in the investigation of sudden unilateral profound hearing loss (SUPHL).…”

Evaluation of vertebrobasilar artery changes in patients with benign paroxysmal positional vertigo

“…The VA tortuosity was defined as unilateral or bilateral VA tortuosity with two or more coils by MRA [8]. To determine VA dominance, the diameter of each vessel was calculated from the vertebrobasilar junction.…”