Vertigo Due to Vascular Mechanisms

Kim, Hyun Ah; Lee, Hyung; Kim, Ji Soo

doi:10.1055/s-0039-3402737

Cited by 7 publications

(3 citation statements)

References 102 publications

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“…Abnormalities in the vertebral arteries account for a large proportion of the causes of vascular dizziness. Many studies have showed that abnormalities in the carotid arteries are associated with symptoms of dizziness in patients (18,19). The vertebral artery-basilar artery ring supplies 1/5 of the blood flow to the brain, and stenosis of the VA may lead to hypoxia and ischemia in the brain, resulting in dizziness (20).…”

Section: Discussionmentioning

confidence: 99%

Impact of craniocervical junction abnormality on vertebral artery hemodynamics: based on computational fluid dynamics analysis

Zhang,

Ai,

et al. 2024

Front. Neurol.

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Background and purposeA three-dimensional reconstruction and data analysis of the vertebral artery (VA) with craniocervical junction abnormality (CJA) was performed by computational fluid dynamics (CFD) based on images to assess the impact of CJA on vertebral artery hemodynamics.MethodsRetrospective analysis of combined head and neck computed tomography angiography (CTA) images of 60 patients with CJA and 60 normal patients admitted to our department from January 2018 to June 2022. The VA was reconstructed in three dimensions using CFD-related software, and the results were visualized to derive vertebral artery lumen diameter (D), peak systolic velocity (PSV), mean blood flow velocity (MV), wall pressure (P), wall shear stress (WSS), normalized WSS (NWSS), etc. Statistical analysis was used to analyze whether the data related to hemodynamics in the CJA group and the control group were statistically significant.ResultsThe lumen diameter of the vertebral artery in the CJA group were less than the control group, and the difference was statistically significant (3.354 ± 0.562 vs. 3.744 ± 0.520, p < 0.05); the PSV, MV, P, WSS, and NWSS of the CJA group were increased compared with the control group, and the difference was statistically significant (1.235 ± 0.182 vs. 1.104 ± 0.145, 0.339 ± 0.063 vs. 0.307 ± 0.042, 24576.980 ± 7095.836 vs. 20824.281 ± 6718.438, 34.863 ± 6.816 vs. 31.080 ± 5.438, 0.272 ± 0.075 vs. 0.237 ± 0.067, p < 0.05).ConclusionIn the complex CJA, the possibility of hemodynamic variation in the VAs is higher than in the normal population. The hemodynamic aspects of the vertebral artery in patients with CJA, such as diameter, flow velocity, flow, wall pressure and shear force, differ from those in the normal population and may lead to the occurrence of clinical symptoms, such as dizziness, so preoperative examinations such as combined head and neck CTA should be performed to clarify the vascular abnormalities.

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Section: Discussionmentioning

confidence: 99%

Impact of craniocervical junction abnormality on vertebral artery hemodynamics: based on computational fluid dynamics analysis

Zhang,

Ai,

et al. 2024

Front. Neurol.

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“…Большое значение современных стандартизированных диагностических клинических протоколов (например, HINTS, TriAGe+) для дифференциации симптома острого головокружения и быстрого выявления его потенциально опасных причин отметили в своем недавнем обзоре A. Zwergal и M. Dieterich. Они рекомендовали с осторожностью интерпретировать нейровизуализационные данные, полученные при МРТисследовании, так как высока вероятность недооценки небольших очагов поражения [5] и центральных вестибулярных нарушений (что обусловлено особенностями кровоснабжения данной артерией), протокол HINTS не столь информативен, в отличие от диагностики, например, инсульта в бассейне задней нижней мозжечковой артерии [30]. К аналогичному выводу пришли H. Lee и соавт., проведя проспективное наблюдение пациентов с инфарктом в бассейне передней нижней мозжечковой артерии, подтвержденным нейровизуализационным исследованием.…”

Section: нейровестибулярное обследование для дифференциального диагно...unclassified

Stroke and peripheral vestibulopathy as a part of acute vestibular syndrome

Исакова

2023

Almanac of Clinical Medicine

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The scope of the review is the problem of differential diagnosis between stroke and peripheral vestibulopathy in patients with acute vestibular vertigo. A vertebrobasilar stroke manifesting with the isolated vertigo has been previously recognized to be extremely rare, and the symptoms have been related to the involvement of peripheral parts of the vestibular analyzer. Recently there has been growing evidence that the isolated vertigo syndrome is commonly related to the central involvement of the vestibular analyzer. The author presents published clinical cases of acute cerebrovascular accident with a single symptom of acute vestibular vertigo. It can be also a symptom of a hemispheric stroke due to an injury of vestibular pathways connecting the vestibular nuclei with the parietal cortex. These observations extend the understanding of the common classic pathognomonic picture of central vestibular vertigo, which implies that its development is related exclusively to the brain matter lesion in vestibulobasilar stroke. Current clinical rating scales and tests (NIHSS, FAST) used for the diagnosis of an acute stroke, are frequently not sensitive to the vertebrobasilar stroke, and neuroimaging, including brain magnetic resonance imaging at DWI mode, may give false negative results. The most informative differential diagnostic method in acute vestibular syndrome is an otoneurological assessment including identification of nystagmus characteristics and head turn impulse test, for the assessment of vestibuloocular reflex and at bed tests (for example, tests included into the HINTS PLUS protocol). In this regard, it is important that neurology specialists in regional vascular centers and departments for acute cerebrovascular care should master the otoneurological assessment skills.

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“…В последнем случае (при инфаркте в бассейне лабиринтной артерии) развивается острый кохлеовестибулярный синдром [28]. Несмотря на то что инсульт в артериях ВБС часто проявляется головокружением в сочетании с очаговой неврологической симптоматикой, малые инфаркты с вовлечением нижней ножки мозжечка, узелка и вестибулярных ядер могут вызвать изолированное головокружение [29,30]. Первичная дифференциальная диагностика острого головокружения проводится в рамках острого вестибулярного синдрома, который, с использованием алгоритма NIHTS+ или его модификаций, далее подразделяется на центральный и периферический [31,32].…”

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Differential diagnosis of ischemic stroke in the arteries of the vertebrobasilar system

Kulesh,

Demin,

Vinogradov

2023

RJTAO

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Stroke in the arteries of the vertebrobasilar system is characterized by a variety of nonspecific symptoms, many mimickers, and often atypical clinical presentation, which, together with the low sensitivity of CT and MRI of the brain, leads to incorrect and untimely diagnosis. This article addresses in detail the issues of differential diagnosis of this disease with Guillain–Barre syndrome, myasthenic crisis, central pontine myelinolysis, multiple sclerosis, Wernicke encephalopathy, vestibular neuronitis, Meniere's disease, and vestibular migraine.

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Vertigo Due to Vascular Mechanisms

Cited by 7 publications

References 102 publications

Impact of craniocervical junction abnormality on vertebral artery hemodynamics: based on computational fluid dynamics analysis

Impact of craniocervical junction abnormality on vertebral artery hemodynamics: based on computational fluid dynamics analysis

Stroke and peripheral vestibulopathy as a part of acute vestibular syndrome

Differential diagnosis of ischemic stroke in the arteries of the vertebrobasilar system

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