Sunday, 17 August 2014

Vertebral artery test

Approximately one‐quarter of ischaemic strokes involve the posterior or vertebrobasilar circulation. Stenosis of the vertebral artery can occur in either its extra‐ or intracranial portions, and may account for up to 20% of posterior circulation ischaemic strokes. Stenotic lesions, particularly at the origin of the vertebral artery, are not uncommon. In an angiographic study of 4748 patients with ischaemic stroke, some degree of proximal extracranial vertebral artery stenosis was seen in 18% of cases on the right and 22.3% on the left. This was the second most common site of stenosis after internal carotid artery stenosis at the carotid bifurcation. Such stenotic lesions are now potentially treatable by endovascular techniques.

In marked contrast with carotid artery stenosis, the optimal management of vertebral artery stenosis has received limited attention, and is poorly understood. This partly reflects difficulties in imaging the vertebral artery adequately, and limited surgical treatment options. Recent improvements in imaging and the arrival of vertebral artery angioplasty, however, have opened up new opportunities for intervention in this disease.

The treatment in such cases is purely medical. However, a Physical Therapist should be aware of this problem, the vertebral artery disease or  vertebrobasilar ischaemia, and should know the basic anatomy, symptoms and assessment test in his everyday practise.

A very nice article on Physiopedia explains these issues clearly.

What to keep in mind:

To test the blood flow in the vertebral artery, one should put the patient on his back and perform an passive extension, followed by a passive rotation of the neck. The rotation should be performed in both directions. The manoeuvre causes a reduction of the lumen at the third division of the vertebral artery, resulting in de decreased blood flow of the intracranial vertebral artery of the contralateral side. It causes an ischemia due to blood loss in the pons and the medulla oblongata of the brain. This results in dizziness, nausea, syncope, dysarthria, dysphagia, and disturbances of the hearing or vision, paresis or paralysis of patients with vertebrobasilar ischaemia.

Below is an alternate vertebral artery test, presented by offers an extended overview of the Vertebrobasilar Occlusion and Vertebral Artery Syndrome, including treatment and management options.

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