engleski

Correlation of vertebral artery hypoplasia and occlusion with clinical findings

The aim of this study was to evaluate epidemiological and clinical findings in patients with vertebral artery hypoplasia (VAH) or occlusion (VAO). We studied a total of 200 patients addmitted to the Department of Neurology with VAH or VAO to estimate the frequency of various risk factors, diagnosis at discharge (categorised as stroke, TIA, vertebrobasilar insuffitiency, or &#8220; other&#8221; - meaning diagnoses not connected with cerebrovascular disorders), brain CT scan findings and most frequent symptoms. According to duplex ultrasonography findings, patients were divided into two groups: hypoplasia of at least one vertebral artery was found in 142 patients and occlusion in 58. The mean diameter of the hypoplastic artery was 1.7 mm. Among 58 patients with VAO, 9 had also carotid occlusion or stenosis >70%. 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 was found in 65, 5% of male patients (p< 0.05). Discharge diagnosis in patients with VAH were: stroke 22, 5%, 12% TIA, 27, 5% vertebrobasilar insuffitiency, and 38, 0% &#8220; other&#8221; diagnosis ; whereas 51, 7% of patients with VAO had stroke, 12, 1% TIA, 25, 9% vertebrobasilar insuffitiency and 10, 3% &#8220; other&#8221; diagnosis ; diagnosis &#8220; stroke&#8221; and &#8220; other&#8221; significantly differed among groups (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 a hystory of 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 ; lesion within the anterior circulation and small deep infarcts in patients with VAO was found in 31% and in 19% with VAH ; the remaining CT scans showed no lesion. 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 ; in patients with VAO: dizziness, motor deficit, nausea, headache, dysarthria, cognitive disturbances, visual field deficit, paresthesia nad loss of consciousness. Conclusions: Vertebral artery hypoplasia is more frequently found in female patients, 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 history of heart disease are a risk factor for vertebral artery occlusion. Duplex ultrasonography is necessary for the evaluation of patients with vertebobasilar symptoms.

vertebral artery hypolasia; vertebral artery occlusion; ultrasound; clinical findings

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