Pathophysiology and Diagnosis of Vertebrobasilar Insufficiency: A Review of the Literature

Abstract Introduction Vertebrobasilar insufficiency is defined as transitory ischemia of the vertebrobasilar circulation. Dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body are the most common symptoms. Objective To review the literature regarding the three available diagnostic testing in patients with dizziness complaints secondary to vertebrobasilar insufficiency (VBI): magnetic resonance angiography; transcranial Doppler ultrasound; and vertebrobasilar deprivation testing. Data Synthesis We selected 28 studies that complied with our selection criteria for appraisal. The most frequent cause of the hemodynamic changes leading to VBI is atherosclerosis. The main clinical symptoms are dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body. Even though arteriography is considered the most important exam to diagnose the disease, the inherent risks of this exam should be taken into consideration. The magnetic resonance angiography has been widely studied and is a good method to identify and localize any occlusions and stenosis in both neck and intracranial great vessels. Conclusion Each patient with a suspected diagnosis of VBI should be individually evaluated and treated, taking in consideration the pros and cons of each diagnostic testing and treatment option.

Imagem no traumatismo craniano / Imaging of traumatic brain injury

A avaliação por imagem do traumatismocranioencefálico (TCE) tem tido importante papel na determinação do pronto diagnóstico de lesões traumáticas intracranianas, definindo conduta terapêutica clínica ou cirúrgica emergencial, posteriormente auxiliandona monitorização terapêutica e permitindo acesso a estimativa mais precisa do prognóstico do paciente.A tomografia computadorizada (TC) é o método por imagem mais adequado no atendimento inicial ao paciente vítima de TCE detectando rapidamente lesõespotencialmente fatais que necessitem de tratamento cirúrgico imediato. A angiotomografia permite diagnosticarlesões vasculares crânio-cervicais potencialmente graves. Após a estabilização clínica destes pacientes a ressonância magnética (RM) contribui no aumento da detecção e na melhor caracterização das lesões traumáticas encefálicas e de suas possíveis complicações tais como herniaçõescerebrais e lesões isquêmicas. Neste artigo serão abordadas as principais lesões traumáticas primárias e secundárias cranioencefálicas e suas principais características à TC e RM, métodos que fornecem importantes informações diagnósticas e prognósticas nos pacientes vítimas de TCE.

The imaging evaluation of traumatic brain injury (TBI) has played an important role in determining the early diagnosis of traumatic intracranial injury, defining therapeutic medical or surgical emergency, subsequentlyassisting in monitoring therapy and allowing access to more accurate estimate of the patient’s prognosis. Computed tomography (CT) imaging is the method most appropriate to the patient in the initial care of TBI victim quickly detecting life-threatening injuries requiring immediate surgicaltreatment. The angiotomography (CTA) allows diagnosing craniocervical vascular lesions potentially serious. After clinical stabilization of these patients magnetic resonance imaging (MRI) contributes to increased detection and better characterization of traumatic brain injuries and its possible complications such as cerebral herniation and ischemic lesions. In this article we will discuss the major primary and secondary traumatic cranioencephalic injuries and its main features on CT and MRI methods that provide important diagnostic and prognostic information in patientsvictims of TBI.