Vertebrobasilar Stroke Symptoms and Diagnosis

Clinical Manifestations

The American Heart Association recommends recognizing ataxia, cranial nerve deficits, visual field loss, dizziness, imbalance, and incoordination as symptoms of vertebrobasilar stroke 1
Patients with vertebrobasilar ischemia or infarction may present with central vestibular symptoms, such as dizziness and vertigo, reflecting brainstem compromise 2
Diplopia can occur due to involvement of ocular motor nerves (III, IV, VI) 2
Perioral numbness is a characteristic sign of bulbar ischemia 2
Blurred vision and visual field loss can result from compromise of the occipital cortex or visual pathways 2
Tinnitus may indicate inner ear or brainstem ischemia 2
Ataxia reflects cerebellar or proprioceptive pathway compromise 1
Bilateral sensory deficits can occur due to involvement of sensory pathways in the brainstem 2
Syncope may occur in cases of severe vertebrobasilar hypoperfusion 2

It is crucial to recognize that these symptoms can be caused by other pathological entities, including cardiac arrhythmias, orthostatic hypotension, and peripheral vestibular disorders 2

The American Heart Association does not specifically address this topic, however, ataxia ipsilateral, cranial nerve deficits, and dissociated sensory loss can occur due to compromise of the posterior inferior cerebellar artery (PICA) 3

The risk of subsequent stroke after a vertebrobasilar TIA is 13% within the first 90 days, with a higher risk in the first week 1

Atherosclerotic disease of large arteries is the most common cause, followed by cardioembolism 4
Atherosclerotic stenosis most commonly affects the origin of the vertebral arteries and the intracranial V4 segment 4

Symptoms can result from two main mechanisms: hypoperfusion due to stenosis or occlusion, and atheroembolism causing brainstem or cerebellar infarcts 2
Compression of the vertebral artery by the transverse process of a vertebra can cause symptoms with head rotation 4

Anatomical variations are more common in the vertebrobasilar circulation than in the carotid circulation and should be considered in clinical evaluation 2
Approximately 5% of individuals have the left vertebral artery originating directly from the aortic arch 2