VERTIGO is the most frequent early symptom associated with arterial insufficiency of the brain stem and adjacent structures. In fact, vertigo may be the only symptom in some attacks.1,2 Changes in arterial flow in the basilar artery are dependent upon cardiac output, which in turn may be dependent upon alterations in posture, blood volume, and peripheral resistance. Blood flow in the basilar artery constantly varies, but under normal circumstances perfusion of the neural tissue is regulated by chemical vasomotor mechanisms. When arteriosclerosis is present, the efficiency of this mechanism is greatly impaired and the remote effects of altered systemic blood pressure, postural change, and movements of the head and neck will be more profound.
Atherosclerosis, although commonly observed in the cervico-cranial circulation, is not the only cause of significant reduction in blood flow. Inadequacy of circulation in the basilar arterial system can result from other forms of arterial narrowing
Fields WS. Arteriography in the Differential Diagnosis of Vertigo. Arch Otolaryngol. 1967;85(5):555–557. doi:10.1001/archotol.1967.00760040557018
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