Basilar migraine - A special variant of migraine caused by transient pathological changes in the area of blood supply to the basilar artery. Headache occurs after the aura that includes dizziness, ataxia, sensory disturbances, visual impairment, hearing impairment. Diagnosis is performed neurological examination methods, REG, Doppler ultrasound or MRI angiography, MRI or brain and spine CT, surdologichesky vestibulogicheskogo and research. Basilar migraine is relieved by inhalation of a mixture of oxygen and carbon dioxide, taking prednisone. Preventive treatment is carried out in mezhparoksizmalny period.
migraine, fraught with the development of a number of complications, the most dangerous of which is acute cerebrovascular accident by type of ischemic stroke. Basilar migraine is a migraine with aura. The name of this variant of migraine was due to the fact that it is dominated by the aura symptoms of the lesion cerebral structures supplying the basilar artery of the brain. Similar basilar symptoms occur in 60% of cases of familial hemiplegic migraine, occurring with muscle weakness. For this reason, one of the fundamental distinguishing features of basilar type migraine is the lack of motor deficit.
The most common basilar migraine is observed in the age range 18-50 years, but can occur in children and in persons over 50 years of age. Predominantly affects women. Pathogenesis and clinical cause certain difficulties experienced by experts in the field of neurology in the diagnosis and treatment of basilar migraine variant.
nicotine dependence, disruption of the normal mode of the day, chronic sleep deprivation, genetic predisposition; women - oral contraceptives, hormonal changes.
In addition, many patients have anamnestic indication of spinal cord injury in the cervical spine or observed the presence of cervical spine pathology: anomalies of the spine, craniovertebral anomalies (eg, Kimerli anomaly Chiari anomaly), spinal instability in the cervical region. This suggests a role cervical nociceptive impulses in the event of basilar migraine paroxysms type.
Traditionally, pathogenetic aspects of occurrence of migraine attacks play a major role reflex vasomotor disturbances. In accordance with this concept basilar migraine arises in connection with such violations in the basilar artery that supplies the brain stem structures, occipital lobes, the cerebellum and the labyrinth of the inner ear. However, a number of researchers believe that the basilar migraine is closely associated with hydrops labyrinth - his reaction to permanent epithelium nociceptive stimulation, cause the development of endolymphatic edema. It is with the involvement of the labyrinth associated high incidence of vestibular dysfunction and presence of cochlear neuritis in some patients with basilar migraine type. On the other hand hydrops may be a complication of migraine.
dizziness, tinnitus, diplopia, ataxia, hearing loss, dysarthria, disturbance of consciousness, sensory disturbances, bilateral visual phenomena (flashes of light spots) or amaurosis. Each of these features is transient and lasts at least 5 min. In some cases, there is a consistent occurrence of a number of aura symptoms, but its total duration does not exceed 1 hour. Transient focal neurological deficit occurs in about half of patients. In rare cases it can be prolonged aura (up to 8 hours), continuing on the background of a headache.
For aura should be intense, usually one-sided, cephalalgia (headache). As a rule, the basilar migraine is characterized by pulsating type cephalgia in the occipital region. However, in some patients the headache has nezatylochnuyu localization. A significant portion of patients with aura occurs substantially heavier rest of migraine paroxysm, in connection with which some of them do not even mention cephalgia in their complaints, which greatly complicates the primary diagnosis of migraine. Nausea and vomiting, as well as light and zvukofobiya only occur in one third of patients. Possible short-term loss of consciousness (syncope), followed by retrograde amnesia.
Basilar migraine is consistent with the occurrence of paroxysms over every few weeks, monthly or every few months. With age, it marked the extinction of the intensity and duration of migraine attacks. Complications basilar migraine type may be a vestibular-cochlear syndrome associated with hydrops maze homolateral cephalgia sensorineural hearing loss, ischemic stroke in vertebrobasilar-basilar basin.
neurologist based on the patient's medical history and interviews with the deletion of the presence of pathological changes in neurological status is migraine paroxysm. One of the most important criteria that determine the basilar migraine is the absence of any organic pathology of the brain (intracerebral tumors, encephalitis, cerebral cysts, brain abscess, hydrocephalus). With a view to its elimination is performed CT or MRI of the brain. Electroencephalography to evaluate the functional state of the cerebral structures. For analysis of cerebral blood supply is carried rheoencephalography, vascular Doppler ultrasound head, MRI of the brain vessels.
Basilar migraine acts indication to the study of the cervical spine. Appointed spine X-ray, MRI or CT of the spine, Doppler ultrasound or CT angiography of vertebral artery. Assessment of auditory function is carried out by the results of audiometry hearing care professional and electrocochleography. A study of the vestibular analyzer includes videooculography, vestibulometriyu, caloric test, electronystagmography. Patients can be identified: hidden spontaneous nystagmus, impaired vestibular reactivity elektrokohleografichesky sign of hydrops, audiometric data of sensorineural hearing loss.
Differentiate basilar migraine type is necessary with Ménière's disease, cervical migraine (zadnesheynyh sympathetic syndrome), vertebral artery syndrome, transient ischemic attack, retinal migraine. The difference is the appearance of cervical migraine focal neurological manifestations simultaneously cephalgia, lack of light and zvukofobii expressed tonic tension of the neck muscles, the presence of trigger points in the cervical spine. Meniere's disease occurs without the headaches and visual disturbances; attack is accompanied by repeated vomiting and nausea, while migraines are observed only at the height of cephalgia. Retinal Migraine usually begins with the formation of the cattle, which are then merged; it is not accompanied by other neurological symptoms typical of basilar migraine.
electrosleep, reflexology, massage of cervical area, hydrotherapy, etc. procedures. In addition, great importance is patient compliance with a series of preventive measures to avoid a new migraine attack. These include the elimination of physical and mental overload, the normalization of the regime of the day, an adequate quantity and quality of sleep, walking, nutrition.