Asian Journal of
Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 3 No. October 10, 2024
Analysis of the Relationship between
Symptoms, Clinical Diagnosis, and Findings of CT-Scan Images to Pictures of
Vertebrobasilar Artery Insufficiency
Sudharmadji1,
Greatavia Meanda Leslie2*,
David Herryanto3
1Universitas
Kristen Duta Wacana, Indonesia
2,3Rumah
Sakit Bethesda Yogyakarta, Indonesia
Email: atmajidr@gmail.com1, Greatavia@gmail.com2,
Davidherryanto3@gmail.com3
Abstract
Vertebrobasilar artery insufficiency (VBI) occurs
when the blood flow to the posterior circulation of the brain, supplied by the
vertebral arteries, becomes inadequate. Frequently, VBI is detected
accidentally through CT-Scan in patients who do not show symptoms directly
related to this condition. This study highlights the importance of
comprehensive evaluation and early screening to improve VBI management. The
main objective of this research is to analyze the relationship between clinical
symptoms, clinical diagnosis, and CT-Scan findings to enhance diagnostic
accuracy and develop more effective treatment strategies. A cross-sectional
design was used in this study, with samples obtained from the medical records
of patients diagnosed with Vertebrobasilar Artery Insufficiency at Bethesda
Hospital Yogyakarta between January and April 2023. The data were analyzed
using the chi-square test and processed with SPSS software. The patient
population was dominated by elderly individuals (73%) and males (60.5%),
although these differences were not statistically significant.The findings
suggest that VBI symptoms vary based on age, with older patients more likely to
exhibit stroke and hemiparesis, while younger patients typically experience
headaches and vertigo. Screening for risk factors like cholesterol and blood
sugar levels is crucial for patients over 45, whereas younger patients may
require additional tests to assess cardiometabolic or hypercoagulation risks.
Early detection through age-appropriate screening is vital for preventing
serious complications and improving patient outcomes. These findings imply that
systematic screening can help identify undiagnosed VBI cases, allowing for
timely and more effective medical intervention.
Keywords: CT-Scan, Vertebrobasilar Insufficiency,
Radiology, Stroke.
INTRODUCTION
Vertebrobasilar artery insufficiency
(VBI) is a condition that occurs when there is insufficient blood flow in the
posterior circulation of the brain, where this area is supplied by two
vertebral arteries that join to form the basilar artery (McGuire & Charbel, 2024). This posterior circulation plays an
important role in providing blood supply to brain areas such as the brainstem,
thalamus, hippocampus, cerebellum, occipital lobe, and medial temporal lobe (Chandra et al., 2017). When there is a disruption in blood flow in the
vertebrobasilar artery, a variety of nonspecific neurological symptoms can
arise, making early diagnosis often challenging. The resulting symptoms often
resemble other conditions, such as dizziness, vertigo, double vision, dysphagia
and hearing loss (Chari & Rauch, 2021). These symptoms result from ischemia in
areas of the brain that receive blood supply from the posterior circulation.
In a global context, VBI is one of the
most important causes of neurological disorders related to blood circulation in
the brain (BAB, 2018). Although the exact prevalence is
difficult to determine due to frequent delays or misdiagnosis, VBI is reported
to affect the elderly population with a high risk of ischemic stroke (Lima et al., 2017). Posterior circulation disorders
account for about 20% of total ischemic stroke cases (Atmadja et al., 2021), so prevention and early detection
efforts are needed to reduce stroke-related mortality and complications. Often,
VBI is diagnosed in patients who initially complain of symptoms that are not
directly related to cerebral circulation disorders, such as migraine or
vestibular disorders (Widiastuti et al., 2022). Therefore, it is important to map
symptom patterns and clinical findings to facilitate faster and more accurate
diagnosis (Britz et al., 2016).
Specifically, a problem encountered in
VBI-related research is the difficulty in correlating presenting clinical
symptoms with diagnostic findings, especially through CT-Scan imaging (Cesur et al., 2023). Although brain imaging such as CT-Scan
is often used to detect abnormalities in the posterior circulation, many cases
of VBI are only discovered incidentally (Chmutin et al., 2022). In addition, there is no clear pattern
in associating clinical symptoms with imaging results. This creates obstacles
in the process of diagnosis and appropriate treatment. Thus, in-depth studies
on the relationship between clinical symptoms, diagnosis, and CT-Scan findings
are needed to improve the accuracy of diagnosis.
Several previous studies have addressed
VBI, but most have focused on general symptoms without specifically examining
the relationship between clinical and radiological findings. Research by (Casani et al., 2021) highlighted that most patients with
symptoms of vertigo and balance disorders are often diagnosed late due to the
absence of typical symptoms in the early stages of VBI. (Chmutin et al., 2022) also pointed out the importance of
multidisciplinary diagnosis to manage patients with VBI, especially by using
CT-Scan as the main diagnostic tool in determining the severity and location of
ischemia. However, studies linking CT-Scan findings directly to symptoms and
clinical diagnosis are still very limited, leading to difficulties in creating
more effective treatment protocols.
The urgency of this study is driven by
the increasing prevalence of cardiovascular disease and stroke risk in the
elderly population, which makes VBI one of the global health problems that
needs more attention. In addition, the complexity of VBI symptoms that often
overlap with other neurological conditions makes this study important in
developing a more precise diagnostic approach. Failure to detect VBI can lead
to inappropriate treatment, which ultimately worsens the patient's condition.
This study has the novelty of combining
clinical and radiological data to analyze the relationship between symptoms,
clinical diagnosis, and CT-Scan findings in patients with suspected VBI.
Although various previous studies have highlighted the importance of a
multidisciplinary approach in the diagnosis of VBI, this study will make a
further contribution by exploring specific patterns of clinical symptoms and
imaging results that may be associated with impaired posterior circulation. As
such, this study may provide new insights into how CT-Scan imaging can be used
to detect VBI earlier and more accurately.
This study aims to analyze the
relationship between clinical symptoms, clinical diagnosis, and CT-Scan
findings with images of vertebrobasilar artery insufficiency in patients. By
combining clinical and radiological data, this study aims to generate a deeper
understanding of VBI and contribute to the development of more effective
diagnostic and therapeutic strategies. The benefits of this study include
providing guidance for medical practitioners, especially in the fields of
neurology, radiology, and vascular surgery, in better diagnosing and managing
VBI. The findings of this study are expected to strengthen the scientific
evidence supporting the importance of using CT-Scan in detecting
vertebrobasilar artery insufficiency and guide the development of more
comprehensive clinical protocols. Overall, this study also has significant
implications in reducing the morbidity and mortality rates associated with VBI,
particularly by improving early detection and appropriate treatment. As such,
this study is expected to contribute to improving the quality of life of
patients with posterior cerebral circulation disorders.
RESEARCH
METHOD
The
research method is quantitative with a cross-sectional design, using secondary
data in the form of medical records of patients with Vertebrobasilar Artery
Insufficiency (VBI) at Bethesda Hospital Yogyakarta. The target population of
this study is patients with VBI. The research sample was taken from the medical
records of VBI patients from January to March 2023. The inclusion criteria were
all patients with VBI who were treated at Bethesda Hospital and had complete
medical record data and radiological images. Exclusion criteria include
patients with incomplete medical record data. The variables in this study are
divided into independent variables and dependent variables. The independent
variables included age, sex, other radiological findings, clinical diagnosis,
and symptoms, while the dependent variables were VBI radiological findings. Age
is categorized in the operational definition as children (< 25 years), young
adults (< 45 years), old adults (<= 55 years), and the elderly (> 55
years). The gender is classified into male and female. Other radiological
findings include atrophy, infarction, CVA, SOP/SOL, SNH, SH, and others, while
clinical diagnosis is established before CT-Scan examination. Symptoms are
categorized into vestibular symptoms, stroke symptoms, a combination of
vestibular and stroke symptoms, and non-vestibular non-stroke symptoms. VBI
radiological findings refer to all radiological findings with increased HU or
other abnormalities in the vertebrobasilar artery.
The
sampling technique used is total sampling, where all samples that meet the
inclusion and exclusion criteria are included to ensure that the collected
samples represent the VBI population. The researcher applied a probabilistic
sampling technique with an overall sample method in this study. The study collected
data from VBI patients undergoing therapy, focusing on age, gender, clinical
diagnosis, and radiological findings. Data analysis was carried out using SPSS.
Data analysis was done using simple and multiple linear regression analysis
methods, with a significance level of p < 0.05. The data collected is used
exclusively for research purposes, and the research is conducted after
obtaining ethical approval from the Bethesda Hospital Health Research Ethics
Committee.
RESULT AND
DISCUSSION
Frequency Data
Analysis and Pearson Chi-Square Test
Table
1. Relationship between Clinical Variables and Radiologic
Findings
in Patients with Vertebrobasilar Artery Insufficiency (VBI)
Variable |
Radiological
Findings (VBI) |
Total |
Result |
||||||
V |
B |
VB |
|||||||
|
n |
% |
n |
% |
n |
% |
n |
% |
p |
Age |
|
|
|
|
|
|
|
|
0.110 |
Children |
3 |
5.3% |
4 |
2.6% |
9 |
4.3% |
16 |
3.8% |
|
Young adults |
5 |
8.8% |
11 |
7.2% |
19 |
9.1% |
35 |
8.4% |
|
Older adults |
6 |
10.5% |
32 |
21.1% |
23 |
11.1% |
62 |
14.8% |
|
Elderly |
43 |
75.4% |
105 |
69.1% |
157 |
75.5% |
305 |
73.0% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
Gender |
|
|
|
|
|
|
|
|
0.059 |
Woman |
30 |
52.6% |
52 |
34.2% |
82 |
39.4% |
165 |
39.5% |
|
Man |
27 |
47.4% |
100 |
65.8% |
126 |
60.6% |
253 |
60.5% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
Atrophy |
|
|
|
|
|
|
|
|
0.632 |
Not |
46 |
80.7% |
113 |
74.3% |
152 |
73.1% |
312 |
74.6% |
|
Yes |
11 |
19.3% |
39 |
25.7% |
56 |
26.9% |
106 |
25.4% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
Infarction |
|
|
|
|
|
|
|
|
0.285 |
Not |
24 |
42.1% |
63 |
41.4% |
72 |
34.6% |
160 |
38.3% |
|
Yes |
33 |
57.9% |
89 |
58.6% |
136 |
65.4% |
258 |
61.7% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
CVA |
|
|
|
|
|
|
|
|
0.886 |
Not |
50 |
87.7% |
136 |
89.5% |
181 |
87.0% |
368 |
88.0% |
|
Yes |
7 |
12.3% |
16 |
10.5% |
27 |
13.0% |
50 |
12.0% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
SOP/ SOL |
|
|
|
|
|
|
|
|
0.468 |
Not |
57 |
100.0% |
146 |
96.1% |
199 |
95.7% |
403 |
96.4% |
|
Yes |
0 |
0.0% |
6 |
3.9% |
9 |
4.3% |
15 |
3.6% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
SNH |
|
|
|
|
|
|
|
|
0.293 |
Not |
56 |
98.2% |
143 |
94.1% |
190 |
91.3% |
390 |
93.3% |
|
Yes |
1 |
1.8% |
9 |
5.9% |
18 |
8.7% |
28 |
6.7% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
SH |
|
|
|
|
|
|
|
|
0.003 |
Not |
51 |
89.5% |
142 |
93.4% |
195 |
93.8% |
388 |
92.8% |
|
Yes |
6 |
10.5% |
10 |
6.6% |
13 |
6.3% |
30 |
7.2% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
Vest |
|
|
|
|
|
|
|
|
0.543 |
Not |
51 |
89.5% |
127 |
83.6% |
170 |
81.7% |
349 |
83.5% |
|
Yes |
6 |
10.5% |
25 |
16.4% |
38 |
18.3% |
69 |
16.5% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
Stroke |
|
|
|
|
|
|
|
|
0.743 |
Not |
29 |
50.9% |
83 |
54.6% |
108 |
51.9% |
221 |
52.9% |
|
Yes |
28 |
49.1% |
69 |
45.4% |
100 |
48.1% |
197 |
47.1% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
Both |
|
|
|
|
|
|
|
|
0.000 |
Not |
54 |
94.7% |
144 |
94.7% |
200 |
96.2% |
398 |
95.2% |
|
Yes |
3 |
5.3% |
8 |
5.3% |
8 |
3.8% |
20 |
4.8% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
Non |
|
|
|
|
|
|
|
|
0.667 |
Not |
37 |
64.9% |
106 |
69.7% |
150 |
72.1% |
294 |
70.3% |
|
Yes |
20 |
35.1% |
46 |
30.3% |
58 |
27.9% |
124 |
29.7% |
|
Total |
57 |
100.0% |
152 |
100.0% |
208 |
100.0% |
418 |
100.0% |
|
Information: |
|||
1. |
VBI |
: |
Obstructive Vertebrobasillaris Artery |
2. |
V |
: |
Vertebral Artery |
3. |
B |
: |
Basillaris artery |
4. |
VB |
: |
Vertebrobasillaris
Artery |
5. |
CVA |
: |
Cerebrovascular
Accident |
6. |
SOP/SOL |
: |
Space Occupying
Lesion / Space Occupying Lesion |
7. |
SNH |
: |
Non-Hemorrhagic Stroke |
8. |
SH |
: |
Stroke Hemorrhagic |
9. |
Vest |
: |
Vestibular Symptoms (dizziness and nausea/vomiting) |
10. |
Stroke |
: |
Stroke Symptoms (hemiplegi and nausea/vomiting) |
11. |
Both |
: |
Vestibular and Stroke Symptoms |
12. |
Non |
: |
Not Vestibular and Stroke Symptoms |
Based on the data of the Radiology Findings
table, it was found:
1. Age
The most common age distribution of
patients is the elderly group, with a percentage of 73% of the total patients.
The percentage of other age groups was smaller: adolescents (3.8%), young
adults (8.4%), and older adults (14.8%). There was no statistically significant
difference between age groups (p = 0.110). The results of the analysis relate
to V, B and VB:
a.
Children: V (5.3%), B (2.6%), VB (4.3%)
b.
Young adults: V (8.8%), B (7.2%), VB (9.1%)
c.
Older adults: V (10.5%), B (21.1%), VB (11.1%)
d.
Elderly: V (75.4%), B (69.1%), VB (75.5%)
The elderly dominated in all categories
with a statistically insignificant difference (p = 0.110).
2.
Gender
Male patients were found more (60.5%) than
female patients (39.5%). Although there was a difference, it was not
statistically significant (p = 0.059). The results of the analysis relate to V,
B and VB:
a.
Female (P): V (52.6%), B (34.2%), VB (39.4%)
b.
Male (L): V (47.4%), B (65.8%), VB (60.6%)
Male patients were more dominant in
categories B and VB, while women were more numerous in category V. This
difference was not statistically significant (p = 0.059).
3.
Atrophy
Most patients did not experience atrophy
(74.6%), while those who experienced atrophy were 25.4%. This difference was
not statistically significant (p = 0.632). The results of the analysis relate
to V, B and VB:
a.
No (N): V (80.7%), B (74.3%), VB (73.1%)
b.
Yes: V (19.3%), B (25.7%), VB (26.9%)
The majority of patients did not experience
atrophy in all categories with a statistically insignificant difference (p =
0.632).
4.
Infarction
More patients had infarction (61.7%) than
those who did not (38.3%). However, this difference was not statistically
significant (p = 0.285). The results of the analysis relate to V, B and VB:
a.
No (N): V (42.1%), B (41.4%), VB (34.6%)
b.
Yes: V (57.9%), B (58.6%), VB (65.4%)
More patients had infarction in all
categories with a statistically insignificant difference (p = 0.285).
5.
Cerebrovascular Accident
Most patients do not experience CVA (88%),
while those who do experience CVA is 12%. This difference was not statistically
significant (p = 0.886). The results of the analysis relate to V, B and VB:
a.
No (N): V (87.7%), B (89.5%), VB (87.0%)
b.
Yes: V (12.3%), B (10.5%), VB (13.0%)
Most patients did not develop CVA in all
categories with a statistically insignificant difference (p = 0.886).
6.
Space Occupying Lesion / Space Occupying Lesion
Most patients did not experience SOP/SOL
(96.4%), while those who experienced it was 3.6%. This difference was not
statistically significant (p = 0.468). The results of the analysis relate to V,
B and VB:
a.
No (N): V (100.0%), B (96.1%), VB (95.7%)
b.
Yes: V (0.0%), B (3.9%), VB (4.3%)
The majority of patients did not experience
SOP/SOL in all categories with a statistically insignificant difference (p =
0.468).
7.
SNH
Most patients did not experience SNH
(93.3%), while those who experienced it was 6.7%. This difference was not
statistically significant (p = 0.293). The results of the analysis relate to V,
B and VB:
a.
No (N): V (98.2%), B (94.1%), VB (91.3%)
b.
Yes: V (1.8%), B (5.9%), VB (8.7%)
Most patients did not experience SNH in all
categories with a statistically insignificant difference (p = 0.293).
8.
SH
Most patients did not experience SH
(92.8%), while those who experienced 7.2%. This difference is statistically
significant (p = 0.003). The results of the analysis relate to V, B and VB:
a.
No (N): V (89.5%), B (93.4%), VB (93.8%)
b.
Yes: V (10.5%), B (6.6%), VB (6.3%)
The majority of patients did not experience
SH in all categories, with a statistically significant difference (p = 0.003).
9.
Vestibular Symptoms
Most patients do not experience VEST
(83.5%), while those who experience it is 16.5%. This difference was not
statistically significant (p = 0.543). The results of the analysis relate to V,
B and VB
a.
No (N): V (89.5%), B (83.6%), VB (81.7%)
b.
Yes: V (10.5%), B (16.4%), VB (18.3%)
Most patients did not experience VEST in
all categories with a statistically insignificant difference (p = 0.543).
10.
Stroke
Most of the patients did not have a stroke
(52.9%), while those who experienced it were 47.1%. This difference was not
statistically significant (p = 0.743). The results of the analysis relate to V,
B and VB:
a.
No (N): V (50.9%), B (54.6%), VB (51.9%)
b.
Yes: V (49.1%), B (45.4%), VB (48.1%)
The distribution of patients who had and
did not have a stroke was almost evenly distributed in all categories with a
statistically insignificant difference (p = 0.743).
11.
Vestibular + Stroke Symptoms
Most patients do not experience BOTH
(95.2%), while those who experience 4.8%. This difference is statistically
significant (p = 0.000). The results of the analysis relate to V, B and VB:
a.
No (N): V (94.7%), B (94.7%), VB (96.2%)
b.
Yes: V (5.3%), B (5.3%), VB (3.8%)
The majority of patients did not experience
BOTH in all categories with a statistically significant difference (p = 0.000).
12.
Non-Vestibular + Stroke Symptoms
Most of the patients did not experience NON
(70.3%), while those who experienced it was 29.7%. This difference was not
statistically significant (p = 0.667). The results of the analysis relate to V,
B and VB:
a.
No (N): V (64.9%), B (69.7%), VB (72.1%)
b.
Yes: V (35.1%), B (30.3%), VB (27.9%)
Most patients did not experience NON in all
categories, with a statistically insignificant difference (p = 0.667).
In general, some statistically significant findings were
found in the SH and BOTH variables, while other variables did not show
significant differences. The elderly age group and male sex were more dominant
in the patient population, with variations in distribution among the categories
of vertebral artery (V), basilar artery (B), and vertebrobasilar artery (VB).
Incidence of VBI
Patients Based on Clinical Manifestations and Symptoms
Based on the clinical manifestations of patients in this
study with a sample of 410 VBI patients, it was found that patients with
complaints of vertigo were reported 55 times (13.41%), while headache was
recorded in 29 cases (7.07%). SNH/SH was the most common manifestation found in
patients, with 214 events or 52.20% of the total findings. Heart disorders were
found in 21 patients (5.12%), while kidney disorders were found in 13 patients
(3.17%). Injuries, trauma, and accidents were recorded in as many as 9 cases
(2.20%) and other categories in as many as 69 findings (16.83%).
The data showed that the incidence of patients with VBI
(Vertebrobasilar Insufficiency) fluctuated over a period of time divided into
ten years. This incidence was analyzed to understand the trends and patterns of
suspicion of VBI in the patient population, both in adolescents, young adults,
old adults, and the elderly. Hopefully, this analysis can help in further
treatment and prevention planning by recognizing symptoms that often appear
based on the existing age range. The following table shows the incidence data
of VBI patients every ten years:
Table 2. Age
Distribution, Incidence, VBI Findings, and Most Common Clinical Symptoms in
Patients with Vertebrobasilar Artery Insufficiency (VBI)
It |
Age Range |
Incidence |
VBI findings |
Most Clinical
Diagnoses/Symptoms |
|||||
V |
B |
VB |
|||||||
1 |
< 20 years |
11 |
1 |
3 |
7 |
CKR, headache, dizziness, KLL trauma |
|||
2 |
21-30 years old |
13 |
3 |
4 |
6 |
Headache |
|||
3 |
31-40 years old |
15 |
2 |
6 |
7 |
Headache, vertigo |
|||
4 |
41-50 years old |
34 |
4 |
12 |
16 |
Stroke, hemiparesis, vertigo |
|||
5 |
51-60 years old |
99 |
12 |
45 |
41 |
Stroke, hemiparesis |
|||
6 |
61-70 years old |
129 |
38 |
112 |
160 |
Stroke, hemiparesis |
|||
7 |
71-80 years old |
87 |
16 |
31 |
40 |
Recurrent stroke, hemiparesis, cephalgia |
|||
8 |
>80 years old |
32 |
2 |
12 |
18 |
Recurrent stroke, complications of the
disease, chronic diseases |
|||
Information: |
|||||||||
1. |
VBI |
: |
Obstructive Vertebrobasillaris Artery |
||||||
2. |
V |
: |
Vertebral Artery |
||||||
3. |
B |
: |
Basillaris artery |
||||||
4. |
VB |
: |
Vertebrobasillaris Artery |
||||||
Based on the table above, it was found
that:
1. Age Range 41-50 Years
and Older: The incidence of VBI increases significantly, especially after age
41. Clinical manifestations such as stroke and hemiparesis are becoming more common.
2. Age Range 51-70 Years:
The highest incidence occurs in the age group of 51-70 years with dominant
symptoms of stroke and hemiparesis.
3. Age <40 Years: The
incidence is relatively lower with major complaints such as headaches and
vertigo.
4. Age >80 Years:
Although incidence decreases after age 80, complications of chronic disease and
recurrent stroke remain a major concern.
The study highlights
the importance of early detection and treatment of VBI, especially in older age
groups, to prevent more serious complications.
Discussion
The vertebrobasilar
system, which consists of the vertebral and basilar arteries, supplies blood to
the brain stem, cervical spinal cord, cerebellum, thalamus, and occipital lobes
(Yuni &
Latupeirissa, 2023). This system includes
bilateral vertebral arteries (VAs) and unpaired basilar arteries (BAs).
Vertebrobasilar Insufficiency (VBI) is a condition in which the blood supply by
the vertebral and basilar arteries to the posterior part of the brain is insufficient
(Dossani et al., 2022). The term VBI began to be used in the 1950s by C. Miller
Fisher to describe transient ischemic attack (TIA) in the vertebrobasilar
region. The vertebrobasilar blood vessels, also known as posterior circulation,
supply areas such as the brainstem, thalamus, hippocampus, and cerebellum, as
well as the occipital lobe and medial temporal vessels. About 25% of stroke and
TIA cases occur in vertebrobasilar distribution. The vertebrobasilar disease
generally occurs in advanced age, especially between 70 and 80 years old, with
a higher prevalence in men. Around 25% of the elderly experience balance
disorders and an increased risk of falling due to VBI. African-Americans also
experience VBI more often than other ethnic groups due to genetic factors,
higher prevalence of hypertension, and disparities in access to health care.
VBI is generally caused
by two main mechanisms: hemodynamic insufficiency and embolism (AC et al., 2016). (1) Hemodynamic Changes: Atherosclerosis, including
arterial calcification, is a major cause of VBI, exacerbated by risk factors
such as smoking, hypertension, and hyperlipidemia. Hemodynamic ischemia is
common in the elderly and people with diabetes due to inadequate blood flow
through the basilar artery, especially when there is occlusion of both
vertebral arteries or basilar arteries, as well as insufficient carotid
circulation contribution. (2) Embolism: Embolism in VBI can originate from
ruptured atherosclerotic plaques or intimal defects due to trauma,
fibromuscular dysplasia, or aneurysm. Most embolisms form from subclavian,
vertebral, or basilar artery lesions. Risk factors include coronary artery
disease and cardioembolism, with diabetes, hypertension, and smoking as the
main risk factors for arterial calcification, including vertebral arteries.
The results showed data on the
incidence, clinical manifestations, and risk factors for vertebrobasilar
insufficiency (VBI) in diverse populations, of which SNH/SH (52.20%) and
vertigo (13.41%) were the most commonly reported symptoms, reflecting the
classic manifestations of VBI that are often found in the literature. These
symptoms mainly reflect ischemia in the brain region supplied by the posterior
circulation. However, variation in symptoms by age suggests that the clinical
presentation of VBI may differ significantly among different age groups, with
older patients more likely to experience symptoms of stroke and hemiparesis. In
comparison, younger patients report headaches and vertigo more frequently.
Heart and kidney disorders have a lower prevalence among VBI patients (5.12%
and 3.17%, respectively), suggesting that while important, they may not be a
major factor in VBI pathophysiology. Conversely, injury or trauma and other
conditions suggest that mechanical and comorbid factors may also play a role in
the clinical development and manifestation of VBI.
Analysis of CT-Scan findings showed a
significant correlation between radiological findings and clinical symptoms,
indicating the importance of imaging in diagnosing and managing VBI. Stenosis
and occlusion of the vertebral and basilar arteries are often found in patients
with more severe symptoms, supporting the main role of atherosclerosis in VBI
pathophysiology (Sathya
et al., 2022). Atherosclerotic plaques and lacunar
infarctions found in the posterior circulatory region confirm the importance of
cardiovascular risk factors such as hypertension, diabetes, smoking, and
hyperlipidemia in the development of VBI. Medical therapy with antiplatelets
and anticoagulants is an important strategy to prevent further thrombus and
embolism, which is a serious complication of VBI (Mikkelsen
et al., 2015). Surgical interventions such as
stenting and bypass grafting may also be considered in patients with
significant stenosis. An emphasis on early detection and timely management is
essential to prevent more serious complications such as ischemic stroke, which
often has a significant long-term impact on a patient's quality of life.
The data
obtained showed that various clinical symptoms in patients, such as vertigo,
headache, stroke, hemiparesis, and others were suspected to be caused by
undetected Vertebrobasilar Insufficiency (VBI). These symptoms vary based on
age range, with different incidences and manifestations in each age group.
Therefore, proper screening for VBI is needed according to the age range and
existing symptoms. Here are some VBI recommendations based on the results of
the research:
1. For patients under 20 years old, it is
recommended to have a basic neurological and cardiovascular examination,
especially for those who have complaints of dizziness, headache, or a history
of trauma. It aims to detect VBI disorders early, particularly those related to
head trauma, and prevent further complications. The risk of head injury,
headache, and dizziness can affect daily activities, and academic development
can be minimized through early detection and appropriate treatment. From the
results of this study, symptoms such as dizziness and headache can indicate the
presence of VBI, so basic neurological and cardiovascular screening is very
important. For the age of 21-30 years, recurrent headaches should be followed
up with follow-up examinations such as imaging (CT/MRI) if there are recurrent
symptoms. The purpose of screening is to identify the cause of headaches and
prevent the development of neurological disorders. Recurrent headaches in this
age range can interfere with productivity and quality of life, so proper
treatment is needed to prevent more serious chronic conditions. In the 31-40
age group, symptoms such as headache and vertigo must be evaluated
comprehensively to ensure the absence of missed VBI. However, further research
is still needed with a larger sample number to determine the urgency and need
for VBI screening at the age of <40 years.
2. In the age range of 41-50 years, stroke
and hemiparesis symptoms must be watched and examined intensively, given the
high risk and increased number of VBI incidences obtained. Screening and
prevention of stroke with early intervention and managing cardiovascular risk
factors such as monitoring blood pressure, cholesterol, and blood sugar is
highly recommended, especially related to the main etiopathogenesis of VBI
involving atherosclerosis.
3. The age group of 51-60 has a high
incidence of stroke and hemiparesis, so it requires routine testing for early
detection of VBI. This screening aims to reduce the incidence of stroke through
holistic management of health conditions. This is important because, in the age
range of 61-70, the peak incidence of VBI is highest, with the main symptoms of
stroke and hemiparesis in most patients, so early detection may be needed.
4. Aged 71-80 years, with a high risk of
recurrent stroke and hemiparesis, requires regular check-ups and assessments of
the patient's condition to prevent the emergence and/or worsening of existing
chronic diseases. For patients over the age of 80, comprehensive examination
and palliative management are necessary to optimize quality of life and prevent
serious complications of VBI.
Thus,
early detection of VBI through appropriate screening according to the age range
and existing symptoms is very important to prevent serious complications and
improve patients' quality of life. Systematic and regular screening can help
identify VBIs that are not detected beforehand, allowing for more effective and
timely medical interventions.
CONCLUSION
Research
shows that vertebrobasilar artery insufficiency (VBI) is most common in the
elderly (73% of patients) and less common in children, adolescents, and young
adults. Men are more likely to develop VBI than women (60.5% vs. 39.5%),
although this difference is not statistically significant. Radiological
analysis showed a significant correlation between the SH findings and the
clinical symptoms of VBI (p = 0.003) and between vestibular and stroke symptoms
(p = 0.000). Common symptoms of VBI include vertigo, headache, and stroke, with
age variations affecting their prevalence—stroke and hemiparesis are more
common in older patients. In comparison, headaches and vertigo are more common
in younger patients. Cardiovascular risk factors such as hypertension,
diabetes, and hyperlipidemia play an important role in the development of VBI.
Early detection through screening according to age and symptoms is essential to
prevent serious complications and improve patients' quality of life. Systematic
screening can help identify undetected VBIs, allowing for more effective
medical interventions.
BIBLIOGRAPHY
AC, L. N., Bittar, R.,
Gattas, G. S., Bor-Seng-Shu, E., Oliveira, M. L., Monsanto, R. D. C., &
Bittar, L. F. (2016). Pathophysiology and
Diagnosis of Vertebrobasilar Insufficiency: A Review of the Literature. International
Archives of Otorhinolaryngology, 21(3), 302–307.
Atmadja, A. S., Dwiputra, H., Kembuan, M.
A. H. N., & Warouw, F. (2021). Ischemic Stroke Anterior And Posterior
Circulation: Characteristic Comparison And Risk Factors In Kandou Central
Hospital Manado Patients. Jurnal Sinaps, 4(1), 1–5.
BAB, V. (2018).
Gangguan Vestibular Sentral. Bunga Rampai Vertigo, 73.
Britz, G. W., Agarwal, V., Mihlon, F.,
Ramanathan, D., Agrawal, A., Nimjee, S. M., & Kaylie, D. (2016). Radial
artery bypass for intractable vertebrobasilar insufficiency: case series and
review of the literature. World Neurosurgery, 85, 106–113.
Casani, A. Pietro, Gufoni, M., &
Capobianco, S. (2021). Current insights into treating vertigo in older adults. Drugs
& Aging, 38(8), 655–670.
Cesur, S., Multu, B., Baysal, B., Dogan,
M., & Özbilenacar, G. (2023). Investigation of the Relationship Between
the Dynamic Properties of the Vertebrobasilar Artery and Vestibular Symptoms.
Chandra, A., Li, W. A., Stone, C. R., Geng,
X., & Ding, Y. (2017). The cerebral circulation and cerebrovascular disease
I: Anatomy. Brain Circulation, 3(2), 45–56.
Chari, D. A., & Rauch, S. D. (2021).
The efficient dizziness history and exam. Otolaryngol Clin North Am, 54,
863–874.
Chmutin, G., Antonov, G., Chmutin, E.,
Fedyanin, A., Livshitz, M., Oleynikov, B., Zokhidov, Z., & Shumadalova, A.
(2022). Diagnostic Investigations as a Basis for Optimising Surgical Management
of Vertebrobasilar Insufficiency Syndrome. Frontiers in Surgery, 9,
901759.
Dossani, R. H., Cappuzzo, J. M., Waqas, M.,
Almeida, N., & Levy, E. I. (2022). Posterior Circulation Stroke and
Vertebrobasilar Insufficiency. Introduction to Vascular Neurosurgery,
311–330.
Lima, A. C., Bittar,
R., Gattas, G. S., Bor-Seng-Shu, E., Oliveira, M. de L., Monsanto, R. da C.,
& Bittar, L. F. (2017). Pathophysiology
and diagnosis of vertebrobasilar insufficiency: a review of the literature. International
Archives of Otorhinolaryngology, 21, 302–307.
McGuire, L. S., & Charbel, F. T.
(2024). A narrative review of techniques for surgical revascularization of the
extracranial vertebral artery in vertebrobasilar insufficiency. Neurochirurgie,
70(1), 101512.
Mikkelsen, R., Dalby, R. B., Hjort, N.,
Simonsen, C. Z., & Karabegovic, S. (2015). Endovascular treatment of
basilar artery thrombosis secondary to bilateral vertebral artery dissection
with symptom onset following cervical spine manipulation therapy. The
American Journal of Case Reports, 16, 868.
Sathya, B. V., Amelia, P., Kesava, M.,
Sunitha, K., & Rakesh, G. V. (2022). Vertebral Artery Stenosis: A Narrative
Review. Cureus, 14(8).
Widiastuti, M., Rachman, I. A., & Umar,
N. (2022). Tatalaksana
Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan
Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma. Jurnal
Neuroanestesi Indonesia, 11(2), 83–94.
Yuni, A., &
Latupeirissa, A. (2023). Asuhan Keperawatan Gawat Darurat Pada Pasien Dengan
Non Hemoragic Stroke (NHS) Di IGD Rumah Sakit Bhayangkara Makassar. STIK Stella Maris.
Copyright holders:
Sudharmadji, Greatavia Meanda Leslie, David
Herryanto (2024)
First publication right:
AJHS - Asian Journal of Healthy and Science
This article is
licensed under a Creative Commons
Attribution-ShareAlike 4.0 International