A blockage or decrease in blood supply to the brain can cause a person to have a stroke. A vertebrobasilar (VB) stroke is a type of stroke that affects the posterior circulation system and requires emergency medical attention.

Stroke is the fifth leading cause of death in the United States. VB strokes account for roughly 20% of all strokes.

This article outlines what a VB stroke is and discusses its causes, symptoms, treatment options, outlook, and more.

Medical professionals pushing someone in a hospital bed to get emergency treatment for a vertebrobasilar stroke.Share on Pinterest
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A 2022 article notes that a VB stroke occurs due to an interruption of blood flow in the posterior circulation system.

The posterior circulation system supplies blood to the following parts of the brain:

  • brain stem
  • thalamus
  • cerebellum
  • occipital lobe
  • temporal lobes

This type of stroke is fairly uncommon. However, the mortality rate for this type of stroke is higher than those related to the anterior circulation system.

This may be due to the more discreet symptoms that resemble non-stroke medical conditions.

If a person has a sudden VB stroke, they often experience nausea or vertigo. This can delay the appropriate neurological evaluation, which can prevent or delay time-dependent treatment options.

Without these medical interventions, a person’s risk of death is higher.

A stroke occurs due to a blockage of the blood supply to part of the brain. It may also occur when a blood vessel in the brain bursts.

The brain requires oxygen to work effectively. The body’s arteries supply the brain with oxygen-rich blood, which provides the brain with this oxygen.

If something blocks or restricts the blood flow to the brain, the brain cells will begin to die within minutes. This is because they will not be receiving the oxygen they require. It is this process that causes a stroke.

A VB stroke occurs when there is an interruption to blood flow in the posterior circulation system. This causes brain cells in specific parts of the brain to die, resulting in a stroke.

Risk factors

Risk factors for a VB stroke include:

Common symptoms of a VB stroke include:

Clinical signs of a VB stroke include:

  • limb weakness on one side
  • gait ataxia, which refers to abnormal movements when walking
  • abnormal movements in the upper limbs on one side
  • dysarthria, which is a speech disorder that occurs as a result of muscle weakness
  • nystagmus, which refers to uncontrollable movement in the eyes

If a person has a stroke, they require care from a team specializing in stroke care. This may include neurologists, neurosurgeons, and neuro-intensivists.

A person may then require rehabilitation with physical, occupational, and speech therapists.

If a person has a VB stroke, their treatment will depend on whether the stroke was an ischemic stroke or a hemorrhage stroke.

An ischemic stroke occurs due to blocked or narrowed arteries, and a hemorrhage stroke happens when a blood vessel in the brain has burst, and blood has leaked into the brain.

Ischemic VB stroke

Treatment for these types of VB stroke tends to focus on restoring adequate blood flow to the brain.

This treatment is time-dependent. If a person receives treatment within 4.5 hours of the VB stroke and they have not experienced a hemorrhage, they may be able to receive a tissue plasminogen activator (TPA).

TPA is an effective treatment for dissolving clots, which can help restore a good supply of blood to the brain.

A medical professional will usually administer TPA intravenously. They may also use a blood thinner, such as aspirin, to help treat a VB stroke and improve blood supply to the brain.

A person may also require a thrombectomy. This is a surgical procedure that allows a surgeon to manually remove a blood clot.

During this procedure, a surgeon may make a hole in the femoral artery at the groin. They will then insert a clot retriever device to remove the blood clot obstructing the blood vessel.

Hemorrhage VB stroke

This is a life threatening condition and often requires immediate surgical treatment.

A person will undergo a CT scan so a medical professional can locate the hemorrhaged vessel and decide on the required specific surgical intervention.

A surgeon may insert an extra ventricular drain through the scalp, which allows them to manually drain the blood and reduce pressure in the brain.

If a person has a hemorrhage VB stroke, medical professionals should control the blood pressure in the brain. To do this, they may intravenously administer antihypertensives. These are medications that lower blood pressure.

A person’s outlook after a VB stroke can depend on several factors:

  • the severity of the stroke
  • the treatment provided
  • the prior baseline function of the brain
  • a person’s age
  • a person’s ability to undergo physical therapy

Some studies suggest that around 21% of people who have a VB stroke experience death or a major disability within 3 months of the stroke.

If a person has a VB stroke due to a blocked blood vessel in the brain, it may lead to an intracranial hemorrhage — a burst blood vessel in the brain. This can cause damage to the brain and is a serious medical emergency.

Another serious complication of a VB stroke is vasogenic or cytotoxic edema.

Vasogenic edema is the term for the buildup of fluid in the brain due to disruption of the blood-brain barrier. Cytotoxic edema is the term for cell swelling due to fluid buildup within the cells.

Both vasogenic and cytotoxic edemas can increase pressure in the brain and may be life threatening.

A person can receive medication to treat this buildup of pressure. However, if they do not work, a person may require a craniectomy.

A craniectomy is a surgical procedure. During this procedure, a surgeon removes a large flap of the skull. This allows space for the swollen brain to bulge and reduces the pressure in the brain.

To diagnose a VB stroke, a doctor may perform several diagnostic tests. These may help the doctor diagnose the specific type of stroke and decide on an effective treatment option.

These include:

  • Physical examination: A doctor may ask about the person’s symptoms and medical history. They may also check the person’s muscle strength, reflexes, sensation, vision, and coordination. During this examination, the doctor may test the person’s blood pressure and look into the blood vessels at the back of their eyes.
  • Blood tests: A doctor may use blood tests to decide whether there is a high risk of bleeding or further blood clots. These tests can look for certain substances in the blood, which can indicate the risk of these outcomes.
  • CT scan: This is a medical imaging test that uses radiation to create cross-sectional images inside the brain from different angles. A CT can show if a person has had a stroke and if hemorrhages are present.
  • MRI scan: This uses radio waves and magnets to create an image of the brain. Medical professionals can use these images to determine if the stroke has caused damage to the brain tissue.
  • Carotid ultrasound: This test allows a doctor to check the blood flow in the carotid arteries. This can help them determine if there is any narrowing or plaque present.
  • Cerebral angiogram: During this test, a doctor injects dye into the blood vessels of the brain to make them visible under an X-ray or MRI scan. This can help the medical team to see a detailed view of the blood vessels in the brain and neck to look for blockages and hemorrhages.

There are several measures a person can take to reduce their risk of a stroke. These include:

  • Following a healthy, balanced diet: A person should eat a diet consisting of plenty of fruits and vegetables. Eating foods low in saturated fats, trans fat, and cholesterol and high in fiber can also help prevent high cholesterol. A person may also wish to limit the amount of salt to help lower their blood pressure.
  • Maintaining a moderate weight: Having overweight or obesity increases a person’s risk of stroke.
  • Being physically active: Physical activity can help a person maintain a moderate weight and lower cholesterol and blood pressure levels. Doctors recommend a person has 2 hours and 30 minutes of moderate-intensity aerobic physical activity each week.
  • Avoiding smoking: Quitting or avoiding smoking can reduce a person’s chances of stroke.
  • Limiting alcohol consumption: Alcohol intake can increase a person’s blood pressure, which can increase their risk of stroke.
  • Managing high blood pressure: If a person has high blood pressure, they should make lifestyle changes or use medications to help reduce it.
  • Managing diabetes: Diabetes can be a risk factor for stroke. A person can manage diabetes through lifestyle changes and medications.

If a person is experiencing symptoms of a VB stroke, they should seek emergency medical care.

Early treatment is very important for a full recovery, and people may require treatment within 4.5 hours of the stroke.

A stroke occurs when something blocks or decreases the blood supply to the brain.

A VB stroke is a type of stroke that occurs due to a blockage in the posterior circulation system. A person may experience dizziness and vertigo, weak limbs, headaches, vomiting, and nausea.

A VB stroke requires immediate medical treatment, which may involve using TPA to dissolve blood clots or surgery to remove clots manually. Other treatments can include anticoagulants, blood thinners, and other surgical procedures.