Vertebro-bazilyarnaya insufficiency
Contents:
Description:
Vertebralno-bazilyarnaya insufficiency is the reversible disturbance of functions of a brain caused by blood supply reduction.
Symptoms Vertebro-bazilyarnoy of insufficiency:
The picture of vertebralno-basilar insufficiency is extremely various. One of the most frequent manifestations of vertebralno-basilar insufficiency is suddenly arising dizziness. Frequency of this sign can be caused by features of blood supply of a vestibular mechanism very sensitive to insufficiency of blood supply.
At most of patients with vertebralno-basilar insufficiency dizziness is shown in the form of feeling of rotation or the rectilinear movement of surrounding objects or own body. Usually dizziness arises quickly and proceeds from several minutes to hours. As a rule, it is followed by frustration in the form of nausea, vomiting, perspiration, change of heart rate and level of arterial pressure. In some cases the patient feels feeling of fall, motion desease, unsteadiness of surrounding space.
Motive disturbances at patients with circulatory disturbances in vertebralno-basilar system consist in development of weakness and awkwardness in extremities.
Frequent manifestation is unilateral decrease in hearing – neurosensory relative deafness.
Reasons Vertebro-bazilyarnoy of insufficiency:
* Acute disorder of cerebral circulation
* Atherosclerosis
* The increased arterial pressure
* Inflammation of vessels (Takayasu's disease, for example)
* Stratification of an artery
* Fibromuscular dysplasia
* Prelums of a subclavial artery hypertrophied scalene.
* Existence of congenital anomalies of development of a vascular bed
* The prelum of a vertebral artery caused by defeat of cervical department of a backbone (a spondylolisthesis, disk hernia)
* Thrombosis of a vertebral and (or) main artery
* The damage of small brain arteries caused by a diabetes mellitus
Treatment Vertebro-bazilyarnoy of insufficiency:
The main directions of treatment of vertebralno-basilar insufficiency are defined by the nature of defeat of vessels.
Regular (daily) control of arterial pressure and obligatory correction of a diet (restriction in a diet of table salt), an exception of consumption of alcohol and smoking, the dosed exercise stresses is necessary. In case of lack of positive effect for 3–6 months, it is necessary to carry out medicamentous therapy. Treatment begins with diuretic, APF inhibitors (captopril, enalapril), blockers of calcium channels (амлодипин, фелодипин), beta-blockers (атенолол, метопролол, бисопролол). If necessary (lack of effect of treatment, bad portability of medicines) replacement by drug from other pharmacological group is made. If in this case the positive effect concerning decrease in level of arterial pressure is not observed, use of complex therapy is necessary (diuretic + APF inhibitor, diuretic + a b-blocker, a beta-blocker + a blocker of calcium channels).
At those patients at whom atherosclerosis is the reason of vertebralno-basilar insufficiency efficiently of prevention of attacks recovery of properties of blood and the prevention of formation of blood clots is. The most widespread drug having protivotrombotichesky effect is acetylsalicylic acid. Now it is considered that an optimum therapeutic dose is administration of drug of 0,5-1,0 mg/kg of weight a day (the patient has to receive daily 50–100 mg of acetylsalicylic acid). The impossibility of use of acetylsalicylic acid demands use of other drugs, in particular, of Dipiridamolum. The daily dose can vary from 75 to 225 mg (25 to 75 mg 3 times a day), in some cases the daily dose can be increased to 450 mg. Dipiridamolum in 1 hour prior to food is accepted, the tablet is not chewed and washed down with a small amount of water. Duration of a course of use of Dipiridamolum usually makes 2–3 months. Cancellation is made gradually, the dose decreases for 1–2 weeks. Drug is contraindicated at an acute myocardial infarction, stenocardia of rest, heavy congestive heart failure, frustration of a cordial rhythm. Modern drugs of protivotrombotichesky action are klopidogret, тиклопидин.
Can promote improvement of cerebral circulation ницерголин. The maintenance dose of a nitsergolin is established individually and makes 5–10 mg 3 times a day. Well proved cinnarizine. Treatment begins with the minimum dosages (12,5 mg 3 times a day) with gradual increase in a dose (25–50 mg 3 times a day after food). Piracetam on 0,8 g 3 times a day for 2 months, Cerebrolysinum on 5–10 ml intravenously of 5-10 introductions on a therapy course are used.
Very convenient combination drug Fezam containing 25 mg of cinnarizine and 400 mg of piracetam is represented. Undoubted advantage of drug is convenience of dosing. The effect is observed at reception of 1-2 capsules 3 times a day. Duration of a course of treatment is defined individually and depends on character and expressiveness of neurologic deficit and averages 1,5–3 months.
Carnitine the hydrochloride is entered intravenously kapelno on 5–10 ml of 20% of solution, on 300–400 ml of normal (isotonic) saline solution, the course of treatment makes 8–12 introductions.
For elimination of attacks of dizziness well proved бетагистин. Betagistin is applied on 8–16 mg 3 times a day. It is reasonable to begin treatment with small doses of drug, if necessary gradually increasing them. Course of treatment long (2–3 months).
For the purpose of the reduction of intensity of episodes of dizziness and the accompanying symptoms (nausea, vomiting) which in particular are provoked the movement it is appointed меклозин. The daily dose is variable and makes from 25 to 100 mg.
