What is a Vertebral Artery?
Before understanding Vertebral Artery Test, let us know first what it is Vertebral Artery. The vertebral artery is one of the largest neck arteries that deliver blood to our brain. This artery’s appropriate position is directly accountable for your heart and brain health.
There is a blood flow restriction in the brain; you are at high risk of having an ischemic attack or stroke. These arteries get blocked over time due to a process known as atherosclerosis, or plaque buildup.
Plaques are composed of cholesterol, calcium, and other biological component deposits. They not only harden the arteries but also develop with time, obstructing or even blocking blood flow to the brain.
Ischemia events, which include decreased blood flow and total blockage of blood flow, have catastrophic consequences on the brain cells.
What is the Vertebral Artery Test?
The Vertebral Artery Test is an examination in physiotherapy to estimate the blood flow of the vertebral arteries to the brain, looking for signs of vertebral artery insufficiency and illness.
Purpose of Vertebral Artery Test
The test narrows the lumen at the third division of the vertebral artery, resulting in reduced blood flow to the contralateral intracranial VA.
It causes ischemia in the pons and medulla oblongata of the brain owing to blood loss.
This causes dizziness, nausea, syncope, dysarthria, dysphagia, hearing or visual abnormalities, paresis, or paralysis in individuals with Vertebrobasilar Insufficiency.
The procedure of the Vertebral Artery Test
Numerous renditions of vertebral artery testing exist depending on the patient’s location.
- The doctor may instruct you to stand motionless, lie on the sofa, or sit.
- It would help if you took a Romberg pose — stand still, feet together, arms outstretched, and eyes closed. Then the patient has to turn the head to the left as much as possible and throw it back from this position.
- Then the person has to repeat the same actions to the right. The patient must be in a free sitting position with their eyes open.
The key idea, however, is to check the cervical spine during head motions to both sides. During the test performance, the doctor must first place 2 MHz transcranial Doppler ultrasound sensors on the patient’s skull with a special helmet. Also, adapt them to the position segments of the posterior cerebral arteries.
The initial pace of blood flow in the posterior cerebral arteries is observed within 1-2 minutes. The person would then be asked to move his head to the left as far as possible, toss it back, and hold this position for 15-20 seconds.
After then, tilt your head back as possible and pull your chin as close to your chest as feasible. When doing each element of this exam, consider subjective (headache, dizziness, nausea, strabismus, etc.) and objective symptoms (the appearance of nystagmus, ataxia, oculomotor disorders, etc.)
Anatomy of vertebral artery
A significant artery in the neck is the vertebral artery. It begins from the posterosuperior section of the subclavian artery and branches from there. Also, It ascends through the transverse processes of the sixth cervical vertebrae’s foramina. Then it coils behind the atlas’ superior articular process.
The vertebral artery is split into four segments:
First Segment of the vertebral artery: The first division runs postcranially between the longus colli and the anterior m scalenus. The pre-foraminal division is another name for the first division.
Moreover, the second division travels cranially across the cervical transverse processes of the cervical vertebrae C2.
Second Segment of the vertebral artery: The foraminal division is another name for the second division.
Third Segment of the vertebral artery: The third division is the portion that rises from C2.
It rises from the latter foramen of the rectus capitis lateralis on the medial side and spirals behind the superior articular process of the atlas.
Forth Segment of the vertebral artery: Lastly, it enters the spinal canal by passing beneath the posterior atlantooccipital membrane, which is located on the top side of the posterior arch of the atlas.
Symptoms Caused by Vertebral artery sickness.
Vertebral artery sickness causes various unpleasant symptoms, including vascular headaches, changes in blood pressure, and vision impairments.
However, the most severe outcomes include transient ischemic attack and a key indicator of approaching stroke.
This test requires specific preliminary findings as it is not entirely without risk. The preliminary examination includes taking blood pressure, arm pulses, and pulses in the common carotid and subclavian arteries and listening for murmurs or bruits.
Anybody experiencing them should seek emergency medical attention. A person suffering from vertebral insufficiency may encounter temporary or permanent symptoms. Among these signs are Loss of eyesight in one or both eyes, Dual vision, spinning sensation, numbness, nausea, slurred speech, dizziness, confusion, difficulty swallowing, and abrupt weakness.
What does a positive Vertebral Artery Test?
If the results of the previous tests are markedly abnormal, this test should not be undertaken. In the absence of any substantial anomalies, the sitting patient is requested to rotate one side of their head while stretching their neck as far as possible.
In the lack of any significant anomalies, the seated patient is asked to spin one side of their head while stretching the neck as far as feasible. In the absence of any substantial abnormalities, the sitting patient is requested to rotate one side of the head while lengthening the neck to the greatest extent possible.
The technique of vertebral artery examination
Before a passive examination, an active range of motion of the cervical spine is frequently conducted; place the patient on their back and do a passive extension and side flexion of the head and neck. Hold a passive neck rotation to the same side for around 30 seconds.
Repeat the test by moving your head to the opposite side.
If there is a drop of the arms, Loss of balance, or pronation of the hands, the test is deemed positive; a positive result implies a reduction in blood flow to the brain. Patients who answer favourably to the Vertebral Artery test may have Vertebrobasilar Insufficiency (VBI). However, VBI cannot be ruled out if they respond negatively. Patients who answer favourably to the Vertebral Artery test may have Vertebrobasilar Insufficiency (VBI).
However, VBI cannot be ruled out if they respond negatively. This test aims to stretch the opposing vertebral artery as much as possible to close the gap in the artery’s wall. Although the extension site with contralateral rotation has been shown to decrease artery diameter, the test’s diagnostic accuracy remains low.
The vertebral artery examination examines the blood flow in the vertebral arteries, looking for signs of vertebral artery insufficiency. Further, a decrease in blood flow might have caused an ischemic attack, a warning sign of stroke.
The vertebral artery arteries deliver oxygen and glucose to areas of the brain that are important for awareness, vision, coordination, balance, and other vital processes. Both reduced blood flow and total blocking of blood flow, known as ischemia episodes, have devastating effects on brain cells. Ischemia happens when blood flow to the brain causes cell damage. When cells die, an infarction develops.
A transient ischemic attack (TIA), sometimes known as a “mini-stroke,” is an ischemic event that causes a brief loss of brain function. A stroke occurs when the subsequent Loss of brain function is irreversible (an infarction or brain attack).
A stroke can trigger a stoppage in the vertebral or the breaking off of a particle of plaque that moves through the artery. Therefore, The vertebral artery examination tests the vertebral artery blood flow, searching for symptoms of vertebral artery insufficiency.