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Incompetent circle of Willis and vertebrobasilar insufficiency
Insights
Vertebrobasilar insufficiency is linked to structural vascular defects, affecting brain blood flow. Incomplete Circle of Willis and blocked arteries significantly increase hindbrain perfusion deficits, causing dysfunction.
Area of Science:
- Neurology
- Vascular Imaging
- Neuroanatomy
Background:
- Vertebrobasilar insufficiency (VBI) presents with diverse neurological symptoms.
- Understanding the vascular underpinnings of VBI is crucial for diagnosis and treatment.
Purpose of the Study:
- To analyze the vascular basis of VBI.
- To compare vascular findings in symptomatic VBI patients with asymptomatic individuals.
Main Methods:
- Magnetic resonance imaging (MRI) and angiography were used.
- 135 subjects with VBI were examined and compared to a control group.
Main Results:
- Symptomatic VBI patients showed significant differences in intracerebral collateralization and regional perfusion.
- Structural defects like stenosis or absence of posterior communicating arteries were noted.
- Occlusion of internal carotid or vertebral arteries combined with an incomplete Circle of Willis heightened hindbrain perfusion deficits.
Conclusions:
- Structural vascular abnormalities are key factors in VBI.
- Impaired collateral circulation and perfusion deficits contribute to hindbrain dysfunction symptoms.
Abstract:
An analysis of the vascular basis of vertebrobasilar insufficiency was derived from the examination of 135 subjects by magnetic resonance imaging and angiography. The data from this cohort were compared to those from normal, ie, asymptomatic, individuals. We concluded that there is a significant difference in the potential for intracerebral collateralization and regional perfusion due to structural defects such as stenosis or developmental absence of the posterior communicating arteries in this symptomatic group. In addition, an occlusion of one or more of the source vessels, the internal carotid and vertebral arteries, in conjunction with an incomplete circle of Willis increased the potential for hindbrain perfusion deficits. Clinical cases illustrate the relationship between failure of internal shunting and the myriad symptoms of hindbrain dysfunction.