Signs and symptoms of vertebrobasilar insufficiency secondary to atherosclerosis: a systematic review

Clinicians face a difficult challenge in identifying vertebrobasilar insufficiency (VBI) resulting from atherosclerosis. VBI is a term utilized to describe a reduction in blood flow to the vertebral and basilar arteries that supply the posterior cerebral system. For musculoskeletal clinicians, diagnostic differentiation of VBI is essential, because its presence directly impacts the clinical use of manual treatment interventions. Clinical guidelines provide a set of cardinal symptoms (inclusive of Coman's 5D's) in which VBI may manifest, the accuracy of which is under contestation because literature provides evidence suggesting a wider set of symptoms.

The objectives of this study were to gather all relevant literature reporting features of VBI pertaining to atherosclerosis, with the aim to help provide evidence that may guide clinical practice in the use of manual therapy interventions and to raise awareness of the manifestations that VBI may present.

Six databases were searched from inception to September 2024 (Allied and Alternative Medicine Database [AMED], AgeLine, SPORTDiscus, Medical Literature Analysis and Retrieval System Online [MEDLINE], Cochrane, and Cumulative Index of Nursing and Allied Health (CINAHL Plus). Articles were screened in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, The included articles required a diagnosis of VBI through clinical examination with radiological evidence of atherosclerotic lesions, without evidence of existing or previous neurological infarcts, concomitant arterial pathology, or any other form of pathological mechanism. Primary data were extracted utilizing a template, and the methodological quality was assessed utilizing the Joanna Briggs Institute critical appraisal tool. Findings were summarized utilizing a narrative synthesis and a table of descriptive statistics.

Two hundred and eighty-three papers were identified, and 15 were included (93 cases, 50M/43F, age 64 years old ± 9 standard deviation [SD] yrs). Vertigo was the most common reported symptom, within a total of 37 different symptoms reported either in isolation or combination. Symptoms inclusive to Coman's 5D's accounted for 22 % of reported features.

Vertigo is the most common symptom (27.7 %) of VBI induced by atherosclerosis. However, there is not sufficient data to make concrete conclusions, although results do instill doubt over the sole use of Coman's 5D's in clinical practice. Prospective observational studies with standardized data extraction for VBI symptoms and their pattern of behavior are warranted.