engleski

HYPOPLASIA AND OCCLUSION OF VERTEBRAL ARTERIES - EPIDEMIOLOGICAL AND CLINICAL EVALUATION

Background The posterior circulation is involved in about 26% of cerebral infarcts. Studies of the relative roles of arterial and cardiac etiologies of cerebral infarction have rarely been performed in the posterior circulation. In territorial cerebellar infarcts, cardiac embolism is the most frequent etiology, while atherosclerotic disease of the vertebral arteries (VA) and VA dissections are next. Borderzone cerebellar infarcts may have a hemodynamic mechanism or may be due to small emboli. Hypoplasia of the vertebral artery is present in 2.3-9.5% in the population. We studied a total of 200 in-patients with vertebral artery hypoplasia (VAH) or occlusion (VAO), in order to estimate the frequency of various risk factors, brain CT scan findings, most frequent symptoms and diagnosis at discharge, categorised as stroke or TIA (anterior circulation), vertebrobasilar insuffitiency, or "other" -meaning diagnoses not connected with cerebrovascular disorders. Results According to color duplex ultrasonography findings (Acuson 128 XP 10), patients were divided into two groups: hypoplasia of at least one vertebral artery was found in 142 patients and occlusion in 58. Among 58 patients with VAO, 9 had also carotid occlusion or stenosis >70%. The mean diameter of the hypoplastic artery was 1.7 mm. The mean age of patients with VAH was 56+/-14 years and with VAO 70+/- 8 years. VAH was revealed in 56.3% of female patients, whereas VAO in 65.5% of male patients (p< 0.05). Hypertension was present in 49.3% of patients with VAH, whereas in 72.4% with VAO (p<0.05) ; statistical significance for diabetes mellitus, total cholesterol, HDL, LDL and triglycerides was not observed. Exactly half of patients with VAO (29) had also heart disease (arrhythmia, myocardiopathy, myocardial infarction or valvular abnormalities) and 17.6% of patients with VAH (p<0.05). Brain CT scan revealed in 24.1% of patients with VAO a lesion within the distribution of posterior circulation, and in 1.4% with VAH. The most frequent symptoms in patients with VAH were as follows: dizziness, headache, motor deficit, nausea, paresthesia, dysarthria, cognitive disturbances, visual field deficit and loss of consciousness. This pattern slightly differed in patients with VAO: dizziness, motor deficit, nausea, headache, dysarthria, cognitive disturbance, visual field deficit, paresthesia and loss of consciousness. Discharge diagnosis in patients with VAH were: stroke 22.5%, TIA 12%, vertebrobasilar insuffitiency 27.5%, and 38% "other" diagnosis ; in patients with VAO 51.7%, 12.1%, 25.9% and 10.3% respectively ; diagnosis "stroke" and "other" significantly differed among groups (p<0.05). Conclusions Vertebral artery hypoplasia is more frequently found in female, whereas occlusion in male patients. Although presenting symptoms at addmission are similar, after diagnostic evaluation patients with VAO more frequently had stroke. A substantial number of patients with VAH is free of related symptoms. Hypertension and heart disease are a risk factor for VAO. Color duplex ultrasonography is necessary for the evaluation of patients with vertebrobasilar symptoms.

vertebral artery occlusion; vertebral artery hypoplasia; epidemiology;

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