Bazilyarny migraine — the special option of migraine caused by passing pathological changes in a zone of blood supply of a bazilyarny artery. The attack of a headache arises after aura which includes dizziness, an ataxy, touch frustration, visual violations, deterioration in hearing. Diagnostics is carried out by methods of neurologic survey, REG, UZDG or the MRT-angiography, MPT or KT of a brain and backbone, surdologichesky and vestibulogichesky researches. Bazilyarny migraine is stopped by inhalation of mix of oxygen and carbon dioxide, Prednisonum reception. Preventive treatment is carried out to the mezhparoksizmalny period.
Bazilyarny migraine — rather seldom found severe form of migraine fraught with development of a number of complications, the most dangerous of which is sharp violation of brain blood circulation as an ischemic stroke. Bazilyarny migraine is migraine with aura. This option of migraine received the name thanks to the fact that in its aura the symptoms characteristic of defeat of cerebral structures, krovosnabzhayemy a bazilyarny artery of a brain prevail. Similar bazilyarny manifestations meet in 60% of cases of the family gemiplegichesky migraine proceeding with muscular weakness. For this reason for one of cardinal distinctive symptoms of migraine of bazilyarny type lack of motor deficiency is considered.
The most often bazilyarny migraine is observed in an age interval of 18-50 years, but can occur at children and at persons is more senior than 50-year age. Women suffer mainly. Features of pathogenesis and clinic cause certain difficulties which are experienced by experts in the field of neurology at diagnostics and therapy of bazilyarny option of migraine.
Reasons of bazilyarny migraine
Factors under the influence of which bazilyarny migraine develops are uniform for all types of migrenozny paroxysms. Carry to them: psycho-emotional overload, excessive use of energy drinks and coffee, nicotine addiction, violation of a normal day regimen, chronic sleep debt, genetic predisposition; at women is reception of contraceptives, hormonal reorganization.
Along with it many patients have an anamnestichesky instruction on a spine injury in cervical department or existence of pathology of cervical department is observed: anomalies of development of a backbone, kraniovertebralny anomaly (for example, Kimerli's anomalies, Kiari's anomaly), instability of a backbone in cervical department. It gives the grounds to assume a certain role of a cervical notsitseptivny impulsation in emergence of paroxysms of migraine of bazilyarny type.
Traditionally in pathogenetic aspect of emergence of the migrenozny attack the main role is assigned to reflex vasomotorial violations. According to this concept bazilyarny migraine arises in connection with similar violations in a bazilyarny artery which krovosnabzhat structures of a brain trunk, occipital shares, a cerebellum and a labyrinth of an inner ear. Together with it a number of researchers consider that bazilyarny migraine is closely connected with a hydrodog of a labyrinth — the reaction of its epithelium to constant notsitseptivny irritation causing development of endolymphatic hypostasis. With involvement of a labyrinth connect the high frequency of vestibular dysfunction and presence of cochlear neuritis at a number of patients with migraine of bazilyarny type. On the other hand can be a migraine complication.
Symptoms of bazilyarny migraine
Bazilyarny migraine is characterized by existence of the aura including at least 2 of the following symptoms: dizziness, noise in ears, a diplopiya, an ataxy, a hearing impairment, a dizartriya, disorder of consciousness, touch violations, bilateral visual phenomena (flash of light, a spot) or . Each of the given signs is tranzitorny and not less than 5 min. last. Consecutive emergence of a number of symptoms of aura is in certain cases noted, however its general duration does not exceed 1 h. Passing focal neurologic deficiency is noted approximately at a half of patients. The prolonged aura (to 8 h) proceeding against the background of a headache is in rare instances possible.
The aura is followed intensive, usually unilateral, by a tsefalgiya (headache). As a rule, bazilyarny migraine is characterized by the pulsing tsefalgiya type in occipital area. However at a number of patients the headache has not occipital localization. At a considerable part of patients the aura proceeds significantly heavier than other part of a migrenozny paroxysm in this connection some of them do not even mention a tsefalgiya in the complaints that considerably complicates primary diagnosis of migraine. Nausea and vomiting, and also sacred and a sound phobia arise only at a third of patients. Short-term loss of consciousness (faint) with the subsequent retrograde amnesia is possible.
Bazilyarny migraine has a stable current with emergence of paroxysms each several weeks, monthly or at an interval of several months. With age fading of intensity and duration of the migrenozny attacks is noted. The vestibulo-cochlear syndrome connected with a hydrodog of a labyrinth, gomolateralny neurotouch relative deafness of a tsefalgiya, an ischemic stroke in the vertebro-bazilyarny pool can act as complications of migraine of bazilyarny type.
Diagnosis of bazilyarny migraine
Bazilyarny migraine is diagnosed by the neurologist on the basis of the anamnesis and the patient's poll on condition of an exception of existence of pathological changes in the neurologic status out of a migrenozny paroxysm. One of the major criteria by which bazilyarny migraine is defined is absence of any organic pathology of a brain (an intracerebral tumor, encephalitis, a cerebral cyst, abscess of a brain, hydrocephaly). For the purpose of its exception it is carried out by brain KT or MPT. The electroencephalography allows to estimate a functional condition of cerebral structures. For the analysis of brain blood supply the rheoencephalography, UZDG of vessels of the head, MRT of vessels of a brain is carried out.
Bazilyarny migraine acts as the indication to a research of cervical department of a backbone. The X-ray analysis of a backbone, MPT or KT of a backbone, UZDG or the KT-angiography of vertebral arteries is appointed. Assessment of acoustical function is carried out by the audiologist by results of an audiometriya and an elektrokokhleografiya. The research of the vestibular analyzer includes a videookulografiya, a vestibulometriya, caloric test, an elektronistagmografiya. At patients can come to light: hidden spontaneous , the broken vestibular reactivity, an elektrokokhleografichesky sign of a hydrodog, audiometric data on neurotouch relative deafness.
It is necessary to differentiate migraine of bazilyarny type with Menyer's disease, cervical migraine (a zadnesheyny sympathetic syndrome), a syndrome of a vertebral artery, the tranzitorny ischemic attack, retinalny migraine. Difference of cervical migraine is emergence of focal neurologic manifestations along with a tsefalgiya, absence sacred and sound phobias, the expressed tonic tension of cervical muscles, existence of trigger points in cervical department of a backbone. Menyer's disease proceeds without headache and visual frustration; the attack is followed by repeated nausea and vomiting while at migraine they are noted only at tsefalgiya height. Retinalny migraine, as a rule, begins with formation of scotomas which then merge; it is not followed by other neurologic manifestations typical for bazilyarny migraine.
Treatment and prevention of bazilyarny migraine
Therapy of migraine of bazilyarny type is rather complex challenge. Use of nonsteroid anti-inflammatory pharmaceuticals (diclofenac, ketoprofen, an ibuprofen, a naproksen and so forth) usually does not stop a paroxysm. Not effective are also triptana (, , , etc.). The combined anesthetics are capable to facilitate a condition of patients during the migrenozny attack. 10-minute inhalation of the gas mix containing 90% of oxygen and 10% of carbon dioxide has good effect. However in usual life this means is inaccessible. In some cases bazilyarny migraine can be stopped by Prednisonum reception. The effect of medicine is highest if it is accepted the first minutes of emergence of aura.
During the mezhparoksizmalny period to patients the treatment directed to strengthening of nervous system is appointed. These are mainly calming pharmacological means (to tofizopa, , ) allowing to reduce emotional lability and to increase resistance of the patient to stressful situations. It is necessary to tell that drug treatment in the sphere of mental health has only auxiliary value. The basic is revaluation of values, change of vital installations and according to habitual psychological reactions. And this work has to be done by the patient. Quieter and benevolent reactions to the taking place events will become its result that will allow the patient to avoid the next migrenozny paroxysms.
At development of a vestibulo-cochlear syndrome and a hydrodog of a labyrinth carry out course treatment by the betaserok which is positively influencing a blood-groove in a bazilyarny artery, improving microcirculation in the field of a labyrinth and stabilizing endolymph pressure. Application of an electrodream, reflexotherapy, massage cervical zones, balneotherapies and so forth procedures is possible. Along with it observance by the patient of a number of the preventive measures allowing to avoid the new migrenozny attack is of great importance. The exception of physical and mental overworks, normalization of a day regimen, adequate quantity and quality of a dream, foot walks, healthy nutrition concerns to them.