Insufficient blood supply of vertebrobasilar arteries in the elderly

　　The etiology of insufficient blood supply to the vertebral and basilar arteries in the elderly is mostly due to cervical spondylosis, cerebral arteriosclerosis, hypertension arteriosclerosis, and other factors such as hypotension, cerebral arteritis, cervical vascular tortuosity, heart disease, vascular malformation, high blood viscosity, and subclavian artery steal syndrome. The vertebral artery originates from both subclavian arteries, ascending through the transverse foramina of the 6th to 1st cervical vertebrae, entering the cranial cavity through the foramen magnum, and merging into the basilar artery below the pons. At the level of the midbrain, it divides into the left and right posterior cerebral arteries. The vertebral and basilar arteries branch out in the cranial cavity, supplying blood to the brainstem, cranial nerves, ascending and descending conduction tracts, auditory and vestibular organs, temporal lobe, occipital lobe, and thalamus, among others. Insufficient blood supply can lead to complex clinical symptoms, which may vary due to the site, extent of injury, and collateral circulation.

　　The pathogenesis of insufficient blood supply to the vertebral and basilar arteries in the elderly can be summarized into the following aspects:

　　1, Hemodynamic changes

　　In patients with a severe narrowing or occlusion of one artery in the vertebral and basilar artery system, blood supply to the area can be maintained by collateral circulation. Once blood pressure drops and cerebral blood flow decreases, the area supplied by collateral circulation can experience transient ischemia.

　　2, Mechanical factors

　　The vertebral artery may become twisted due to arteriosclerosis or congenital curvature, or due to the elongation of the artery, or when the cervical vertebrae are hyperplastic and compress the vertebral artery. When the head and neck are excessively extended, flexed, or turned to one side, insufficient blood supply can often occur.

　　3, Vascular wall lesions

　　The most common is cerebral arteriosclerosis, including both atherosclerosis and hypertension arteriosclerosis. In addition, other factors such as cerebral arteritis, congenital vascular anomalies, vascular injury, etc., may also be involved.

　　4, Other

　　These include conditions such as cerebral arterial steal syndrome, cerebral vascular spasm, hypercoagulable state, severe anemia, etc. In summary, insufficient blood supply to the vertebral and basilar arteries is caused by multiple factors, with the most common being cervical spondylosis, cerebral arteriosclerosis, and hypertension arteriosclerosis.

　　Insufficient blood supply to the vertebral and basilar arteries in the elderly can lead to syncope, electrolyte disorders, cerebral arteriosclerosis, and hemodynamic disorders. When blood pressure drops and cardiac output decreases, insufficient blood supply to the brain tissue can occur. Certain causes of increased blood viscosity, slow blood flow, and changes in blood composition can also lead to insufficient blood supply, microthrombosis, detachment of atherosclerotic plaques, and other complications. Attention should be paid to combining symptoms, imaging, and biochemical tests.

　　The main symptom of insufficient blood supply to the vertebral and basilar arteries in the elderly is paroxysmal dizziness, accompanied by nausea and vomiting, and may include tinnitus and hearing loss.

　　Dizziness often occurs during rapid rotation or change of body position in the head and neck, presenting as rotational, floating, or swinging, with softening of the lower limbs, instability in standing, and a sense of ground movement or inclination. Generally, it lasts for several minutes, hours, or even days.

　　About 40% of those with visual impairment have symptoms such as blurred vision, decreased vision, diplopia, hallucinations, or amaurosis.

　　If the brainstem or cerebellum is damaged, symptoms such as nystagmus, ataxia, balance disorders, swallowing difficulties, dysphonia, and crossed hemiplegia may occur. A few patients may have syncopal attacks. It often occurs suddenly when turning the head quickly, causing the lower limbs to become weak and fall to the ground, with consciousness clear and the ability to stand up by themselves. Recovery occurs within a few seconds or minutes, which is related to the sudden decrease in body muscle tone due to ischemia in the brainstem reticular structure.

　　In addition, there may be symptoms such as migraine, memory loss, and mental abnormalities, and there are a large number of postganglionic sympathetic nerve fibers around the vertebral artery. Therefore, insufficient blood supply from the vertebral and basilar arteries caused by vertebral artery type cervical spondylosis often accompanies autonomic nervous system dysfunction, leading to gastrointestinal, respiratory, and cardiovascular system symptoms. The Horner's sign on the affected side is positive, and there may also be symptoms such as neck pain, posterior occipital pain, and limited neck movement; the positive signs of the nervous system are usually very mild, and there may be horizontal nystagmus, mild pyramidal tract signs (such as muscle weakness, hyperactive or hyperreflexive tendons, asymmetric abdominal wall reflexes, etc.); Romberg's sign is positive, the finger-nose test is inaccurate, and there is a decrease in facial or limb sensation.

　　The elderly should establish a regular lifestyle, pay attention to the combination of work and rest, avoid excessive mental tension and fatigue, and appropriately participate in physical labor or physical exercise within their capabilities. The diet should be light, and calories should be controlled appropriately to avoid obesity. It is recommended to supplement foods rich in protein and vitamins. Smoking and excessive alcohol consumption are important risk factors for cerebrovascular diseases. It is advised to quit smoking and drink alcohol in moderation, which has a positive effect on preventing the occurrence and development of atherosclerosis and controlling insufficient blood supply from the vertebral and basilar arteries.

　　In addition to typical clinical symptoms and physical examination, the diagnosis of insufficient blood supply from the vertebral and basilar arteries in the elderly can also be made based on the results of the following auxiliary examinations.

　　1. Cervical X-ray

　　Including anteroposterior, lateral, oblique, and hyperextension positions, to determine whether the patient has abnormalities such as cervical spondylosis, vertebral disc space narrowing, and cervical disc herniation.

　　2. Transcranial Doppler ultrasound examination (TCD)

　　Based on its spectral image, the average envelope blood flow velocity (vm) and pulsatility index, etc., by detecting the vertebral artery (VA) and basilar artery (BA) from the occipital window, it can be clearly determined whether there is stenosis or spasm in the lumen, and provide evidence for the diagnosis of insufficient blood supply from the vertebral and basilar arteries.

　　3. Brainstem auditory evoked potential (BAEP)

　　It has a definite value for the diagnosis of insufficient blood supply from the vertebral and basilar arteries. Due to the degree of brainstem damage, the onset time, the length of time between BAEP detection and the onset, and the different pathological nature of the lesion itself, all of these can cause differences in the positive rate of BAEP.

　　4. Vestibular function examination

　　The main test is for cold and hot experiments, and some cases show unilateral or bilateral vestibular dysfunction.

　　5, Nystagmus electroencephalogram

　　Can objectively record the direction, speed, frequency, and amplitude of nystagmus, as well as some nystagmus that is difficult to observe with the naked eye.

　　6, Head and (or) cervical CT or MRI examination

　　Understand whether there are other lesions in the brainstem or posterior cranial fossa. Cervical CT examination is clearer than ordinary flat film, and can find changes such as cervical spondylosis, ligament calcification, narrowing of intervertebral spaces, extrusion of cervical intervertebral discs, and vertebral deformities. CT or MRI has the effect of mutual confirmation and complementation in showing stenosis of the transverse process and compression of the vertebral artery. They can be chosen according to circumstances, and have high value in distinguishing insufficient blood supply of the vertebral basilar artery caused by vertebral artery type cervical spondylosis.

　　7, Others

　　Examinations such as blood lipid, blood sugar, blood viscosity, fundus, electrocardiogram, etc., are also helpful in judging insufficient blood supply of the vertebral basilar artery.

　　The diet of elderly patients with insufficient blood supply of the vertebral basilar artery should be light, with more vegetables and fruits, a reasonable diet, and attention to adequate nutrition; avoid smoking, alcohol, coffee, spicy and greasy foods; pay attention to rest and moderate exercise in daily life.

　　Insufficient blood supply of the vertebral basilar artery in the elderly is common in middle-aged and elderly people. Since the cerebellum and brainstem rely on the blood supply of the vertebral-basilar artery, when the vertebral-basilar artery is damaged, the blood flow to the brain is unsmooth and insufficient, and symptoms such as dizziness often occur. This disease belongs to the category of 'Dizziness' and 'Syncope' in traditional Chinese medicine. The pathogenesis is often related to blood deficiency and stasis, combined with Phlegm disturbing upwards and Qi flow being blocked.

　　Symptoms:Patients may experience dizziness, nausea and vomiting, unsteady walking, limb tremors, or blurred vision, or eye tremors, or difficulty in speech. The tongue is dark and pale, with white or yellow greasy fur, the pulse is deep and wiry, or wiry and weak.

　　Treatment Method:Tonify Qi and activate Blood, clear Phlegm-Heat, and warm the meridians.

　　Prescription:30 grams of Astragalus, 12 grams of Red Peony, 12 grams of Chuanxiong, 15 grams of Fritillaria, 15 grams of Angelica Sinensis, 18 grams of Poria, 12 grams of広地龍, 12 grams of Tangerine Peel, 10 grams of Bamboo Shavings, 18 grams of Pueraria Lobata, 9 grams of枳壳, 24 grams of Spatholobus Suberectus, 10 grams of 广佛手, 9 grams of Acorus Tatarinowii, 8 grams of Chen Pi.