This fourth segment gives rise to the posterior inferior cerebellar artery and to the anterior spinal artery (ASA). After piercing the dura and arachnoid at the base of the skull, the fourth segment runs intracranially, and meets the contralateral artery at the midline, in the medullo-pontine junction, to form the basilar artery. The second part (V2) courses within the intervertebral foramina, exiting behind the atlas, giving rise to the third portion (V3) that runs in the direction of the foramen magnum. The first segment (V1) follows the origin of artery until the entrance in the transverse process of the fifth or sixth cervical vertebrae. Starting with the vertebral artery, which arises from the subclavian artery on each side, it divides into 4 segments, 3 extracranial and 1 intracranial. It feeds the posterior region of the brain, including the brainstem, the thalamus, the cerebellum and areas of the occipital and temporal lobes. The VB vascular system comprises the vertebral, basilar and posterior cerebral arteries and their branches. Our purpose is to review the anatomy and the clinical presentation of VB stroke. Thus, both scales are less effective in the diagnosis and identification of high risk cases of posterior circulation ischemic events, 4 highlighting the importance of the recognition of the VB stroke presentation. 3įurthermore, screening tools commonly used to assess patients likely to have an acute stroke, such as the Face Arm Speech Test, or to determine patients with TIA or minor stroke with high risk of recurrence (ABCD2 score) have been primarily evaluated in groups of unselected patients with ischemic events, most of them with anterior circulation strokes. 1 Although traditionally VB stroke is regarded as having a more benign outcome when compared to anterior circulation stroke, data is still conflicting, with some studies showing a higher impairment in VB stroke patients, 2 with 21% of death or major disability at 3 months. It is estimated that nearly a fourth of all transient ischemic attacks (TIA) and strokes occur in the vertebrobasilar (VB) vascular territory.
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