Trunk ischemia/PGS/diagnosis

Vertebrobasilar insufficiency
(VBI) is one of the most common causes of vestibular syndrome in elderly patients. It is caused by brainstem ischemia, begins suddenly, often following dehydration or BP decompensation. Central vestibular syndrome is often accompanied by other trunk symptoms ( dysarthria, diplopia , limb ataxia), but vertigo can be an isolated symptom. VBI is a transient ischemic attack in the vertebrobasilar basin, the symptoms disappear within 24 hours (typically within 1-2 hours), but they can recur in a short time. VBI is therefore a warning of an impending stroke. The etiology is most often thrombotic or embolization stenosis of the arteries of the vertebrobasilar basin (a. vertebralis, a. basilaris , a. labyrinthi, a. cerebelli anterior inferior – AICA, or posterior inferior – PICA). Less frequent causes are compression of the vertebral artery in degenerative changes of the cervical spine, subclavian steal syndrome in stenosis of the subclavian artery (when the flow in the vertebral artery is reversed) or hemodynamic disorders.

Stroke
Symptoms lasting more than 24 hours will occur in the VB of the basin. In the case of a labyrinthine infarction, a sudden peripheral vestibular syndrome occurs, which is long-lasting and causes hearing impairment, which is irreversible. Even with VBI, ischemia of the labyrinth artery can sometimes dominate and manifest itself as a peripheral vestibular syndrome. PICA ischemia causes Wallenberg's syndrome (most often caused by proximal occlusion of the vertebral artery): central vestibular syndrome, diplopia, homolateral facial sensory impairment, Horner's syndrome, paresis of the soft palate, limb ataxia, and contralaterally dissociated heat and pain sensory impairment. In diagnosis, the method of choice is MRI, which better visualizes the posterior fossa area.