| Identifier |
vertebrobasilar_insufficiency_lee |
| Title |
Vertebrobasilar Insufficiency |
| Creator |
Andrew G. Lee, MD; Sami Younes |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (SY) Class of 2022, Baylor College of Medicine, Houston, Texas |
| Subject |
Vertebral Disease; Basilar Disease; Circle of Willis; Cranial Neuropathies |
| Description |
Summary: 1. Vertebral or basilar disease can have both direct and downstream effects in the Circle of Willis 2. Young person presentation a. Vertebral dissection (i.e. neck) can lead to thrombus formation that moves downstream b. Efferent presentations i. Diplopia, nystagmus, CNIII palsy, cranial neuropathies c. Afferent presentations (posterior cerebral arteries) i. Homonymous hemianopsia, bilateral simultaneous loss of vision 3. Old patient presentation a. Atherosclerotic disease, thromboembolic disease from small vessel ischemic disease b. Large vessel disease and stroke i. PICA infarct (i.e. nystagmus, horner syndrome) c. Cardiogenic etiologies (i.e. atrial fibrillation) |
| Transcript |
So today we're going to be talking about vertebrobasilar presentations to neuro-ophthalmology and it could be either the vertebral system or the basilar system. As you know, the vertebral arteries arise and run in the vertebrae, that's why they're called the vertebrals. They're in that vertebral foramen and then they meet as the basilar artery and then terminate as the posterior cerebral arteries, so we have to worry about both the direct effects as well as the downstream effects of vertebral or basilar disease. And of course then that forms the rest of the circle of Willis. So today we're talking about only the posterior circulation here. So in a young person the thing that we're worried about is a dissection, a tear with a false lumen, the vertebral dissection, and so that usually presents to us as downstream thromboembolic disease. So when we have vertebral dissection, either from trauma or sometimes from no cause, the tear can form a thrombus and then the thrombus can fly up. And normally these are extracranial dissections, they're in the neck, and then the vertebral dissection can be on the right side and you can have symptoms on both sides or either side because once it gets into the basilar, it can go to either side. So even though the lesion is on the right, the problem might actually be on the left. And so because we have different branches from the basilar artery, including basilar perforators into the brainstem. That means we can have both efferent presentations, double-vision, third nerve palsies, cranial neuropathies of various types, and afferent complaints which are gonna be either a homonymous hemianopsia, if it goes to the PCA, be a contralateral homonymous hemianopia, or if it is in both, they might get bilateral simultaneous loss of vision that can manifest at various degrees of severity, count fingers, hand motion, no light perception even. So, in an older person, it's usually vertebrobasilar disease from the usual suspects, atherosclerotic disease and thromboembolic disease from small vessel ischemic disease. But large vessel disease can also occur in the vertical basilar system and cause strokes. For example, you might get a PICA infarct from a vert dissection and that's gonna be the Wallenberg, the PICA's the posterior inferior cerebellar artery. That might present to us as a nystagmus or horner syndrome, and so when you're thinking about vertebrobasilar disease, you can think about it as thrombembolic disease, artery to artery embolus. If you're a young person in that setting, we're thinking about dissection, if you're an older person, you still have to think about dissection, but we're more concerned with the usual suspects and it could be more proximal disease from the heart, so it just went into the vertebral basilar system but it came from the heart, so cardiogenic ideologies, atrial fibrillation all still at play. And you should know it can present with diplopia and nystagmus on the efferent side and on the afferent side because the posterior cerebral artery is the terminal artery for this basilar artery, we can get a homonymous hemianopsia in the occipital lobe or bilateral juxtaposed homonymous hemianopsias and cortical visual loss from vertebral vascular disease. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6qp24bt |
| Setname |
ehsl_novel_lee |
| ID |
1680637 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6qp24bt |
