Curriculum · ENT, Ophthalmology, and Dermatology
Vertebrobasilar ischaemia as a cause of dizziness
What it is
Vertebrobasilar insufficiency is a central cause of vertigo, that is a lesion of the brainstem and central connections. Beside it in that list are posterior inferior cerebellar artery syndrome, basilar migraine, cerebellar disease, multiple sclerosis, tumours of the brainstem and fourth ventricle, epilepsy and cervical vertigo. The peripheral list, lesions of the end organs and the vestibular nerve, is the one it has to be told apart from: Ménière's disease, benign paroxysmal positional vertigo, vestibular neuronitis, labyrinthitis, vestibulotoxic drugs, head trauma, perilymph fistula, syphilis and acoustic neuroma.
How it presents
An elderly patient with dizziness on extension of the neck. As a cause of syncope it is described as sudden in onset and unprovoked, and very rare, and the physical finding is a focal neurologic deficit.