Vertebrobasilar circulatory disorders

Vertebrobasilar circulatory disorders are conditions in which the blood flow to the back of the brain is reduced or blocked. This can cause a transient ischemic attack (TIA) or an ischemic stroke.

In the neck, two vertebral arteries join to form the basilar artery, which enters the skull. These are the main blood vessels that provide blood flow to the back of the brain.

The areas in the back of the brain that receive blood from these arteries are needed to keep a person alive. These areas regulate breathing, heart rate, swallowing, vision, movement, and posture or balance. All of the nervous system signals that connect the brain to the rest of the body pass through the back of the brain.

Many different conditions may reduce or stop blood flow in the back part of the brain. The most common risk factors are smoking, high blood pressure, diabetes, increased age, and a high cholesterol level. These are similar to the risk factors for any stroke.

Other causes include:

• Tear in the wall of an artery (vertebral artery dissection) after a neck injury or a sudden neck movement
• Abnormal heart rhythms resulting in blood clots in the heart that travel to the vertebral or basilar arteries and cause a stroke
• Blood vessel inflammation (vasculitis)
• Connective tissue diseases
• Problems in the spinal bones of the neck
• The neck being overextended or rotated such as when being shampooed (called "beauty parlor syndrome"). This position can reduce the blood flow through a vertebral artery in people with certain risk factors (rare).

Common symptoms may include:

• Difficulty pronouncing words, slurred speech
• Difficulty swallowing
• Double vision or vision loss
• Numbness or tingling, most often on the face or scalp
• Sudden falls (drop attacks)
• Vertigo (sensation of things spinning around)
• Confusion or temporary memory loss

Other symptoms may include:

• Bladder or bowel control problems
• Poor balance
• Headache or sudden neck pain, especially if caused by vertebral artery dissection
• Hearing loss
• Muscle weakness
• Nausea and vomiting
• Pain in one or more parts of the body, which gets worse with touch and cold temperatures
• Loss of coordination
• Sleepiness or sleep from which the person cannot be awakened
• Sudden, uncoordinated movements
• Sweating on the face, arms, or legs (uncommon)
• Hiccups

You may have the following tests, depending on the cause:

• CT or MRI of the brain
• Computed tomography angiography (CTA), magnetic resonance angiography (MRA)
• Duplex ultrasound of the neck arteries
• Blood tests, including blood clotting studies
• Echocardiogram
• Electrocardiogram (ECG) and Holter monitor (24-hour ECG)
• X-rays of the arteries (angiogram)

Vertebral or basilar symptoms that start suddenly are a medical emergency that needs to be treated right away. Treatment is similar to that for stroke. Depending on how long you have had symptoms, among other factors, a medicine may be infused to break open any blood clots. A catheter may be inserted into a blood vessel to remove a clot. Some people receive both treatments.

To prevent the condition and lower the risk for future strokes, your health care provider may recommend:

• Taking medicines to help prevent blood clots. Depending on the cause, these may include aspirin, clopidogrel (Plavix), or anticoagulants (blood thinners) such as warfarin, apixaban (Eliquis), or rivaroxaban (Xarelto)
• Eating a healthy diet
• Medicine to lower cholesterol and better regulate blood pressure
• Exercising regularly
• Losing weight
• Stopping smoking
• Treating atrial fibrillation

Procedures to open narrowed vertebral or basilar arteries are used only in certain people because their benefits remain uncertain.

The outlook depends on:

• The amount of brain damage
• What body functions have been affected
• How quickly you get treatment
• How quickly you recover

Each person has a different recovery time and need for long-term care. Problems with moving, thinking, and talking often improve in the first weeks or months. Some people will keep improving for months or years.

Complications of vertebrobasilar circulatory disorders are the same as for a stroke. These include:

• Breathing (respiratory) failure (which may require the use of a machine to help the person breathe)
• Lung problems (especially lung infections)
• Heart attack
• Lack of fluids in the body (dehydration) and swallowing problems (sometimes requiring tube feeding)
• Problems with movement or sensation, including paralysis and numbness
• Formation of blood clots in the legs
• Vision loss
• Recurrent stroke

Complications caused by medicines or surgery may also occur.

Call 911 or the local emergency number right away if you suddenly develop:

• Difficulty speaking or understanding speech
• Weakness or numbness of the face, arm, or leg
• Sudden dizziness or loss of balance
• Double vision or sudden vision loss
• Severe difficulty walking
• Sudden severe headache with no known cause
• Trouble swallowing
• Sudden confusion or decreased alertness

Biller J, Schneck MJ, Ruland S. Ischemic cerebrovascular disease. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 65.

Goldstein LB. Ischemic cerebrovascular disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 376.

Kim JS, Caplan LR. Vertebrobasilar disease. In: Grotta JC, Albers GW, Broderick JP, et al, eds. Stroke: Pathophysiology, Diagnosis, and Management. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 26.  

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467. PMID: 34024117 pubmed.ncbi.nlm.nih.gov/34024117/.

National Institute of Neurological Disorders and Stroke website. Stroke overview. www.ninds.nih.gov/health-information/stroke/stroke-overview. Updated January 7, 2026. Accessed August 27, 2026.

Last reviewed on: 8/19/2024

Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.