Background
Vertebrobasilar atherothrombotic disease (VBATD) describes a wide spectrum of clinical entities with a common pathophysiology. Transient ischemic attacks (TIAs) in this vascular territory are also referred to as vertebrobasilar insufficiency (VBI). This more commonly used term was developed in the 1950s when Fisher introduced the term carotid insufficiency to describe TIAs of the anterior circulation. These, in turn, frequently serve as the prodrome to carotid branch infarcts. Although carotid insufficiency has been dropped from common medical jargon, vertebrobasilar insufficiency persists as the term that encompasses all TIA syndromes of the posterior circulation. In this article, vertebrobasilar atherothrombotic disease describes both transient and permanent ischemic deficits as they affect posterior cerebral circulation.
Vertebrobasilar atherothrombotic disease (VBATD) deserves special attention among emergency physicians because it is difficult to diagnose and important not to misdiagnose. Signs and symptoms of VBATD overlap those of other more common benign entities (eg, labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo).