[Vertebrobasilar flow: clinical manifestations and diagnostic approaches]

The role of the damaged function of the brain and brain stem of vascular origin is very important in human pathology, especially today when these lesions are frequent, and prevention and elimination of consequences are complex. In practice vertebrobasilar insufficiency is a very important diagnostic problem. The aim of the paper is to point to the most frequent symptoms of vertebrobasilar dysfunction and to evaluate some diagnostic (electrophysiologic and neuroradiologic) procedures for the detection of a lesion.

The examination concerned the patients with symptoms and signs of the damaged vertebrobasilar torcular, hospitalized at the Department of Urgent Neurologu of the Clinical Centre of Serbia in Belgrade, from January 1 to December 31, 1990. The diagnosis was made on the basis of the clinical picture and electrophysiologic and neuroradiologic findings. On the basis of these findings the patients were divide in groups 1-5. According to the duration of symptoms and signs of the disease the following damages were observed: transitory ischaemic attack, reversible ischaemic neurologic dificiency and total ischaemic cerebral stroke.

Fifty patients (36 men and 14 women), aged from 18 to 74 years, were examined. According to the localization of the lesion 20 patients belonged to group 2 (vascular area of a cerebelli inferior anterior). Definite infarct lesion was diagnosed in 32 patients (Table 1). The results of electrophysiologic examinations (auditive evoked potentials, somatosensorial evoked potentials, blink reflex, electroencephalographic screenint) were positive in 27-50% of examined patients (Tables 2, 3). The results of neuroradiologic examinations (vertebral angiography-19 patients and computed tomography-40 patients) were statistically significant in comparison to electrophysiologic results.

In everyday practice the diagnosis of vertebrobasilar dysfunctions, and especially of transitory attacks of vertebrobasilar insufficiency, may be an important problem because of a large number of symptoms and signs with frequent alterations. The symptoms of this torcular are diverse and they reflect many structures in a limited area which, if minimaly damaged, cause important neurologic deficiency. Instead of a conclusion, we wish to emphasize that, in addition to the clinical picture, the use of different electrophysiologic methods in the diagnosis of vertebrobasilar failure is needed, as with these methods the preservation of function of different nuclei and ways, can be secured. A far as the neuroradiologic methods are concerned, computed tomography of the head must be obligatory when cerebellar or supratentorial elsions of vertebrobasifar torcular are suspected, or when the aetiology of the disease is not clear. Vertebral angiography should only be carried out when all non-invasive methods are exhausted.