1
|
Choi JW, Qiao Y, Mehta TI, Wilson JN, Torigoe TH, Tsappidi S, Jonathan Zhang Y, Brown SC, Hui FK, Abruzzo T. Safety and efficacy of dynamic catheter-directed cerebral digital subtraction angiography for diagnosis of bowhunter syndrome spectrum disorders: A systematic review of the literature. Interv Neuroradiol 2024:15910199241236820. [PMID: 38477583 DOI: 10.1177/15910199241236820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Dynamic catheter-directed cerebral digital subtraction angiography (dcDSA) is the gold standard for diagnosing dynamic vascular occlusion syndromes such as bowhunter syndrome (BHS). Nonetheless, concerns about its safety exist and no standardized protocols have been published to date. METHODS We describe our methodology and insights regarding the use of dcDSA in patients with BHS. We also perform a systematic literature review to identify cases of typical and atypical presentations of BHS wherein dcDSA was utilized and report on any procedural complications related to dcDSA. RESULTS Our study included 104 cases wherein dcDSA was used for the diagnosis of BHS. There were 0 reported complications of dcDSA. DcDSA successfully established diagnosis in 102 of these cases. Thirty-eight cases were deemed atypical presentations of BHS. Fourteen patients endorsed symptoms during neck flexion/extension. In eight cases, there was dynamic occlusion of bilateral vertebral arteries during a single maneuver. Three patients had multiple areas of occlusion along a single vertebral artery (VA). An anomalous entry of the VA above the C6 transverse foramen was observed in four patients. One patient had VA occlusion with neutral head position and recanalization upon contralateral lateral head tilt. CONCLUSION Our study highlights the safety and diagnostic benefits of dcDSA in characterizing the broad spectrum of BHS pathology encountered in clinical practice. This technique offers a powerful means to evaluate changes in cerebral blood flow and cervical arterial morphology in real time, overcoming the constraints of static imaging methods. Our findings pave the way for further studies on dcDSA to enhance cross-sectional imaging methods for the characterization of BHS and other dynamic vascular occlusion syndromes.
Collapse
Affiliation(s)
- Joo Won Choi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, Houston, TX, USA
| | - Tej I Mehta
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jessica N Wilson
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Trevor H Torigoe
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Samuel Tsappidi
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Y Jonathan Zhang
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
- Department of Neurosurgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Stacy C Brown
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Neuroscience Institute, The Queen's Medical Center, Honolulu, HI, USA
| | - Ferdinand K Hui
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Department of Neurointerventional Surgery, The Queen's Medical Center, Honolulu, HI, USA
- Neuroscience Institute, The Queen's Medical Center, Honolulu, HI, USA
| | - Todd Abruzzo
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| |
Collapse
|
2
|
Kitade I, Kawabata A, Yonemura Y, Takahashi A. Imaging and Clinical Findings after Auto-mobilization in a Cervical Disk Herniation Patient with Prolonged Neck Pain: A 7-year Follow-up Case Report. Prog Rehabil Med 2022; 7:20220062. [PMID: 36561294 PMCID: PMC9741952 DOI: 10.2490/prm.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background Auto-mobilization (AM) is a treatment method that patients can use by themselves for pain relief. We report the case of a patient diagnosed with cervical disk herniation (CDH), with frequent recurrences of upper limb numbness and neck pain. The patient experienced a favorable outcome after cervical spine AM, as evidenced by the immediate and long-term relief of his symptoms as well as changes observed through imaging. Case A 33-year-old-man diagnosed with CDH presented with frequent recurrences of upper limb numbness and neck pain. Radiographic and T2-weighted magnetic resonance imaging scans revealed cervical spine kyphosis and a left paracentral to intraforaminal lesion with disk herniation of protrusion type at C4-5. He was started on AM to elicit physiological lordosis of the cervical spine. This treatment was painless and did not cause withdrawal on discontinuation. AM improved the mobility of his cervical lower facet joints, reduced dysesthesia, and eliminated pain. Improvement in neck pain and cervical kyphosis and reduction of disk herniation were observed 2 years after initiating the intervention. Discussion Appropriate physical therapy evaluation and cervical AM for this patient resulted in symptomatic relief and indirect disk herniation regression. By adding imaging findings to clinical findings, the effect of AM could be visualized, and the reliability of the therapeutic effect was further enhanced.
Collapse
Affiliation(s)
- Ippei Kitade
- Division of Rehabilitation Medicine, University of Fukui
Hospital, Eiheiji, Japan
| | - Akihiro Kawabata
- Division of Rehabilitation Medicine, Echizen Municipal Ota
Hospital, Echizen, Japan
| | - Yoshimasa Yonemura
- Division of Rehabilitation Medicine, Echizen Municipal Ota
Hospital, Echizen, Japan
| | - Ai Takahashi
- Division of Rehabilitation Medicine, University of Fukui
Hospital, Eiheiji, Japan, Department of Orthopaedic Surgery, University of Fukui,
Eiheiji, Japan
| |
Collapse
|
3
|
Okano I, Salzmann SN, Winter F, Chiapparelli E, Hoshino Y, Shue J, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The diagnostic accuracy of MRI and nonenhanced CT for high-risk vertebral artery anatomy for subaxial anterior cervical spine surgery safety. J Neurosurg Spine 2022; 36:261-268. [PMID: 34560654 DOI: 10.3171/2021.4.spine21481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Medial migration of the vertebral artery (VA) can be a risk factor for injury during anterior procedures. CT angiography (CTA) has been considered the gold standard for the evaluation of various areas of the arterial anatomy. MRI and nonenhanced CT are more commonly used as routine preoperative imaging studies, but it is unclear if these modalities can safely exclude the anomalous course of the VA. The aims of this cross-sectional observational study were to investigate risk factors for medially migrated VA on CTA and to evaluate the diagnostic accuracy of MRI and nonenhanced CT for high-risk VA anatomy in the subaxial cervical spine. METHODS The records of 248 patients who underwent CTA for any reason at a single academic institution between 2007 and 2018 were reviewed. The authors included MRI and nonenhanced CT taken within 1 year before or after CTA. An axial VA position classification was used to grade VA anomalies in the subaxial cervical spine. The multivariable linear regression analysis with mixed models was performed to identify the risk factors for medialized VA. The sensitivity and specificity of MRI and nonenhanced CT for high-risk VA positions were calculated. RESULTS A total of 175 CTA sequences met the inclusion criteria. The mean age was 63.8 years. Advanced age, disc and pedicle levels, lower cervical levels, and left side were independent risk factors for medially migrated VA. The sensitivities of MRI and nonenhanced CT for the detection of grade 1 or higher VA position were only fair, and the sensitivity of MRI was lower than that of nonenhanced CT (0.31 vs 0.37, p < 0.001), but the specificities were similarly high for both modalities (0.97 vs 0.97). With the combination of MRI and nonenhanced CT, the sensitivity significantly increased to 0.50 (p < 0.001 vs MRI and vs CT alone) with a minimal decrease in specificity. CONCLUSIONS Axial images of MRI and nonenhanced CT demonstrated high specificities but only fair sensitivities. Nonenhanced CT demonstrated better diagnostic value than MRI. When combining both modalities the sensitivity improved, but a substantial proportion of medialized VAs could not be diagnosed.
Collapse
Affiliation(s)
- Ichiro Okano
- 1Spine Care Institute, Hospital for Special Surgery, New York, New York
- 2Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | | | - Fabian Winter
- 1Spine Care Institute, Hospital for Special Surgery, New York, New York
| | | | - Yushi Hoshino
- 1Spine Care Institute, Hospital for Special Surgery, New York, New York
- 2Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
- 3Department of Orthopedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Jennifer Shue
- 1Spine Care Institute, Hospital for Special Surgery, New York, New York
| | - John A Carrino
- 4Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Andrew A Sama
- 1Spine Care Institute, Hospital for Special Surgery, New York, New York
| | - Frank P Cammisa
- 1Spine Care Institute, Hospital for Special Surgery, New York, New York
| | | | | |
Collapse
|
4
|
Okuma Y, Hirotsune N, Ahmed U, Miyara SJ, Daido S, Kagawa Y. A Case of Intracranial Vertebral Artery Stenosis Treated with Percutaneous Transluminal Angioplasty and Stenting Guided by Brain Oximetry. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1395:127-131. [PMID: 36527626 DOI: 10.1007/978-3-031-14190-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Surgical treatment should be considered for patients with severe vertebrobasilar artery (VBA) stenosis or progressive symptoms, but there is currently no clear treatment algorithm. We report a case of symptomatic intracranial vertebral artery stenosis with repeated cerebral infarction treated by percutaneous transluminal angioplasty (PTA) and stenting and monitoring of oxygen saturation by a brain oximeter. The patient was a 76-year-old man referred to our hospital due to infarction in the right cerebellum. Angiography showed 60% stenosis in the right vertebral artery and 90% stenosis in the left vertebral artery with progressive stenosis in the left. The patient was treated with intravenous and oral triple antiplatelet therapy but had dizziness again with new cerebral infarctions in the left cerebellum and right pontine. We shaved the patient's hair up to the superior nuchal line and placed left and right oximeter probes on each cerebellar hemisphere (2 cm lateral and 2 cm caudal from the external occipital protuberance). Under evaluation of blood flow in the posterior circulation with INVOS Cerebral/Somatic Oximeter, PTA and stent placement were performed for left vertebral artery stenosis. Postoperatively, the dizziness disappeared, and the patient was discharged on his own with good outcome. He has not had a recurrent stroke in over 6 years. Although medical treatment is generally considered the first choice for VBA stenosis, recurrent cerebral infarction occurs at a high rate in symptomatic lesions, and the prognosis is poor. In addition, the perioperative complication rate is not low, and there is no established method for evaluating perfusion of posterior circulation. The brain oximeter is already known to be useful in carotid artery (CA) revascularisation. In this report, we were able to perform a minimally invasive evaluation of blood flow in the posterior circulation using the brain oximeter which might be useful for surgical revascularisation not only in CA but also in VBA.
Collapse
|
5
|
Kavakli AS, Kavrut Ozturk N, Ozdemir F, Ayoglu RU, Sagdic K, Sarionder Gencer E. Cerebral Microinfarct During Cervical Plexus Block for Carotid Endarterectomy. J Cardiothorac Vasc Anesth 2019; 33:1797-1798. [PMID: 30732917 DOI: 10.1053/j.jvca.2019.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Ali Sait Kavakli
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Nilgun Kavrut Ozturk
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fatma Ozdemir
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Raif Umut Ayoglu
- Department of Cardiovascular Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Kadir Sagdic
- Department of Cardiovascular Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Elif Sarionder Gencer
- Department of Neurology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| |
Collapse
|
6
|
Creighton DS, Marsh D, Gruca M, Walter M. The application of a pre-positioned upper cervical traction mobilization to patients with painful active cervical rotation impairment: A case series. J Back Musculoskelet Rehabil 2017; 30:1053-1059. [PMID: 28505959 DOI: 10.3233/bmr-169644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Cervical rotatory thrust manipulation has been associated with adverse patient reaction and damage to the V3 segment of the vertebral artery (VA). OBJECTIVE To document and describe the effects of an upper cervical (UC) traction based mobilization on participants with restricted and painful cervical rotation and to document if the mobilization changed blood flow velocity through the vertebral artery. METHODS This case series examined the effects of a traction based spinal mobilization on two different groups of participants. Group I included 93 participants with restricted bilateral cervical rotation that was also painful at end range. Group II included 30 different participants whose VA blood flow velocity was examined during the same mobilization. Pre- and post-mobilization active cervical rotation, pain intensity levels, and VA blood flow velocity during mobilization was documented. RESULTS Paired T-tests were used to determine statistical significance for changes in cervical rotation, and VA blood flow velocity during mobilization. Ninety-three participants in group I demonstrated an average increase of 16 degrees of cervical rotation. No participant demonstrated an increase in pain, and no participant in group II (N= 30) demonstrated a change in VA blood flow velocity. CONCLUSIONS The application this UC traction based mobilization improved active cervical rotation, end range rotation pain response, did not cause pain during its application and did not alter blood flow through the VA during application.
Collapse
Affiliation(s)
- Douglas S Creighton
- Physical Therapy Program, School of Health Science, Oakland University, Rochester, MI, USA
| | - Doug Marsh
- Physician and Statistician, Melvindale, MI, USA
| | | | | |
Collapse
|
7
|
Chen CC, Chung CY, Lee TH, Chang WH, Tang SF, Pei YC. Increased risk of posterior circulation infarcts among ischemic stroke patients with cervical spondylosis. Neuropsychiatr Dis Treat 2015; 11:273-8. [PMID: 25678792 PMCID: PMC4322877 DOI: 10.2147/ndt.s77967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cervical spondylosis is one of the extrinsic factors causing vertebral artery stenosis. Several case studies have reported compression of the vertebral artery induced by cervical osteophytes that has resulted in posterior circulation infarcts (POCI). However, to the best of our knowledge, no studies have yet analyzed differences in the risk factors and stroke subtypes between ischemic stroke patients with cervical spondylosis and those without. PURPOSE In the case-controlled study reported here, we analyzed the risk factors and stroke subtypes in ischemic stroke patients with and without cervical spondylosis. Characteristics in all the recruited patients with POCI and non-POCI were further compared to extract other risk factors that could predict the occurrence of POCI. METHODS AND PATIENTS We filtered out ischemic stroke patients with cervical spondylosis ("Stroke+C" group) by International Classification of Diseases, Ninth Revision codes. We analyzed the data of 38 subjects in the Stroke+C group and 152 sex- and age-comparable ischemic stroke patients without cervical spondylosis ("Stroke-C" group). We recorded the demographic characteristics including sex and age, and stroke risk factors, including diabetes mellitus, hypertension, heart disease, hyperlipidemia, and smoking habits. The stroke classifications were defined by the Oxford Community Stroke Project classification. All subjects were further categorized into POCI or non-POCI groups. The ultrasound findings of the vertebral arteries (extracranial and intracranial) in the Stroke+C group were also recorded. RESULTS More patients in the Stroke+C group tended to have POCI (34.2%) than patients in the Stroke-C group (17.5%) (odds ratio [OR] =2.41, P<0.05). Furthermore, hypertension (OR=3.41, P<0.01) and cervical spondylosis (OR=2.41, P<0.05) were two independent risk factors for POCI in ischemic stroke patients. CONCLUSION Ischemic stroke patients with cervical spondylosis are more prone to POCI than those without cervical spondylosis. Hypertension is another identified risk factor for POCI in ischemic stroke patients. The occurrence of POCI should be highlighted for patients with cervical spondylosis.
Collapse
Affiliation(s)
- Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chia-Ying Chung
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wei-Han Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Simon Ft Tang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan ; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
8
|
Tissue damage markers after a spinal manipulation in healthy subjects: a preliminary report of a randomized controlled trial. DISEASE MARKERS 2014; 2014:815379. [PMID: 25609853 PMCID: PMC4291009 DOI: 10.1155/2014/815379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/10/2014] [Indexed: 01/30/2023]
Abstract
Spinal manipulation (SM) is a manual therapy technique frequently applied to treat musculoskeletal disorders because of its analgesic effects. It is defined by a manual procedure involving a directed impulse to move a joint past its physiologic range of movement (ROM). In this sense, to exceed the physiologic ROM of a joint could trigger tissue damage, which might represent an adverse effect associated with spinal manipulation. The present work tries to explore the presence of tissue damage associated with SM through the damage markers analysis. Thirty healthy subjects recruited at the University of Jaén were submitted to a placebo SM (control group; n = 10), a single lower cervical manipulation (cervical group; n = 10), and a thoracic manipulation (n = 10). Before the intervention, blood samples were extracted and centrifuged to obtain plasma and serum. The procedure was repeated right after the intervention and two hours after the intervention. Tissue damage markers creatine phosphokinase (CPK), lactate dehydrogenase (LDH), C-reactive protein (CRP), troponin-I, myoglobin, neuron-specific enolase (NSE), and aldolase were determined in samples. Statistical analysis was performed through a 3 × 3 mixed-model ANOVA. Neither cervical manipulation nor thoracic manipulation did produce significant changes in the CPK, LDH, CRP, troponin-I, myoglobin, NSE, or aldolase blood levels. Our data suggest that the mechanical strain produced by SM seems to be innocuous to the joints and surrounding tissues in healthy subjects.
Collapse
|
9
|
Wynd S, Westaway M, Vohra S, Kawchuk G. The quality of reports on cervical arterial dissection following cervical spinal manipulation. PLoS One 2013; 8:e59170. [PMID: 23527121 PMCID: PMC3604043 DOI: 10.1371/journal.pone.0059170] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 02/13/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed. PURPOSE 1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports. METHODS A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT. RESULTS Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors. CONCLUSIONS This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.
Collapse
Affiliation(s)
- Shari Wynd
- Texas Chiropractic College, Pasadena, Texas, United States of America.
| | | | | | | |
Collapse
|
10
|
The diagnosis of vertebrobasilar insufficiency using transcranial Doppler ultrasound. Case Rep Med 2012; 2012:894913. [PMID: 23251187 PMCID: PMC3509548 DOI: 10.1155/2012/894913] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 11/18/2022] Open
Abstract
Background. Vertebrobasilar insufficiency (VBI) is a hemodynamic posterior circulation transient ischemic attack (TIA) caused by intermittent vertebral artery occlusion that is induced by a head rotation or extension. VBI may result from large vessel atherosclerotic disease, dissection, cervical compressive lesions, and subclavian steal phenomenon. Diagnostic transcranial Doppler (TCD) of VBI disease and hemodynamic posterior circulation TCD monitoring in symptomatic positions might prove a useful tool in establishing the diagnosis. Patient and Material/Method. A 50-year-old Caucasian man presented with a one-year history of episodic positional vertigo and ataxic gait that were induced by a neck extension and resolved by an upright position or a neck flexion. Computed tomography angiogram (CTA) and TCD confirmed the presence of VBI where no blood flow was detected through posterior cerebral arteries in the symptomatic position (head extension position). Conclusion. TCD is a promising noninvasive technique that might have a role as a diagnostic test in VBI.
Collapse
|
11
|
Dandamudi VS, Thaler DE, Malek AM. Cerebral embolus following chiropractic manipulation in a patient with a calcified carotid artery. J Neuroimaging 2012; 23:429-30. [PMID: 22818061 DOI: 10.1111/j.1552-6569.2012.00706.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Dissection of the cervicocranial vessels is the principal cause of ischemic brain injury following cervical spinal manipulation. Cervical spinal manipulation leading to cerebral embolus in the absence of dissection is not described in the literature. Current case documents cerebral embolism originating from extensively calcified internal carotid artery immediately following cervical spinal manipulation in the absence of dissection. METHODS We describe a case and imaging findings of a 63-year-old male who underwent cervical spinal manipulation and developed sudden onset of left-arm numbness and weakness. RESULTS Computed tomography angiography demonstrated extensively calcified right internal carotid artery at the site of redone carotid endarterectomy as well as calcified embolus in the right inferior middle cerebral artery. CONCLUSIONS Calcified carotid artery may be at risk for embolization following cervical spinal manipulation. Our recommendation is that, patients with extensively calcified carotid arteries should refrain from aggressive neck maneuvers and cervical spine manipulation therapy to avoid liberation of cerebral embolus.
Collapse
Affiliation(s)
- Venkata S Dandamudi
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, MA 02111, USA
| | | | | |
Collapse
|
12
|
Choi JM, Hong HJ, Chang SK, Oh SH. Cerebellar infarction originating from vertebral artery stenosis caused by a hypertrophied uncovertebral joint. J Stroke Cerebrovasc Dis 2012; 21:908.e7-9. [PMID: 22365284 DOI: 10.1016/j.jstrokecerebrovasdis.2011.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/24/2011] [Accepted: 09/27/2011] [Indexed: 11/26/2022] Open
Abstract
We report a case of cerebellar infarction originating from vertebral artery stenosis caused by a hypertrophied uncovertebral joint. A 38-year-old man presented with sudden onset of headache, dizziness, and dysarthria. The magnetic resonance imaging scan of the brain revealed acute infarction in the right cerebellar hemisphere in the territory of the posterior inferior cerebellar artery (PICA) and superior cerebellar artery (SCA). Magnetic resonance, 3-dimensional computed tomographic, and conventional angiography revealed severe right vertebral artery stenosis by extrinsic compression of the hypertrophied right C5-C6 uncovertebral joint. The diagnosis was acute cerebellar infarction, which was probably caused by embolism from the right vertebral artery stenosis that was caused by the hypertrophied C5-C6 uncovertebral joint. C5-C6 anterior discectomy and fusion were performed together with direct uncovertebral joint decompression. Postoperative 3-dimensional computed tomographic angiography revealed improvement in antegrade filling in the right vertebral artery. The imaging findings for this patient and the pathogenesis of cerebellar infarction for our patient are discussed.
Collapse
Affiliation(s)
- Jong Mun Choi
- Department of Radiology, Daejin Medical Center, Gyeonggi-do, Korea
| | | | | | | |
Collapse
|
13
|
Abstract
SYNOPSIS This clinical commentary provides evidence-based information regarding adverse cerebrovascular events in the context of manual therapy assessment and management of the cervical spine. Its aim is to facilitate clinical decision making during diagnosis and treatment of patients presenting to the therapist with cervicocranial pain. Rather than focusing on a traditional view of premanipulative testing as the cornerstone for decision making, we present information concerning the clinical presentation of specific vascular conditions. Additionally, we discuss the assessment and management of musculoskeletal pain in the presence of risk factors for cerebrovascular accident. It is proposed that vascular "red flag" presentations mimic neuromusculoskeletal cervicocranial syndromes. Invariably, the 2 conditions coexist. This reasoning presupposes that some patients who have poor clinical outcomes, or a serious adverse response to treatment, may be those who actually present with undiagnosed vascular pathology. We use 2 case reports to demonstrate how incorporating vascular knowledge into clinical reasoning processes may influence clinical decision making. LEVEL OF EVIDENCE Level 5.
Collapse
|
14
|
Cervical arterial dysfunction and manual therapy: A critical literature review to inform professional practice. ACTA ACUST UNITED AC 2008; 13:278-88. [DOI: 10.1016/j.math.2007.10.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 10/29/2007] [Accepted: 10/30/2007] [Indexed: 11/23/2022]
|
15
|
Kerry R, Taylor AJ, Mitchell J, McCarthy C, Brew J. Manual therapy and cervical arterial dysfunction, directions for the future: a clinical perspective. J Man Manip Ther 2008; 16:39-48. [PMID: 19119383 PMCID: PMC2565074 DOI: 10.1179/106698108790818620] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This paper offers a contemporary, evidence-based perspective on the issue of adverse neurovascular events related to cervical spine manual therapy. The purpose of this perspective is to challenge traditional thought and practice and to recognize areas where practice and research should develop. By considering the themes presented in this paper, the clinician can broaden his or her approach to neurovascular assessment in line with contemporary evidence and thought. We present information based on clinically relevant questions. The nature of vertebrobasilar insufficiency and the utility of pre-treatment testing are examined in light of contemporary evidence. In addition, we report on internal carotid artery pathology, and the significance of appreciating atherosclerosis in clinical decision-making. These later two areas are not commonly recognized within manual therapy literature, and we suggest that their importance to differential diagnosis of head and neck pain, as well as estimating treatment related risk, is paramount. We propose that the term cervical arterial dysfunction is more appropriate than classically used nomenclature. This term refers more accurately and completely to the range of pathologies at different anatomical sites that manual therapists treating patients with head and neck pain are likely to encounter. Finally, we present a brief review of the medico-legal status pertaining to this area. Although this is English law-related, the themes derived from this section are of interest to all manual therapists.
Collapse
|
16
|
Abstract
OBJECTIVE To identify adverse effects of spinal manipulation. DESIGN Systematic review of papers published since 2001. SETTING Six electronic databases. MAIN OUTCOME MEASURES Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports. RESULTS The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature. CONCLUSIONS Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.
Collapse
Affiliation(s)
- E Ernst
- Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK.
| |
Collapse
|
17
|
Abstract
OBJECTIVE To identify adverse effects of spinal manipulation. DESIGN Systematic review of papers published since 2001. SETTING Six electronic databases. MAIN OUTCOME MEASURES Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports. RESULTS The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature. CONCLUSIONS Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.
Collapse
Affiliation(s)
- E Ernst
- Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK.
| |
Collapse
|
18
|
Cagnie B. Author’s reply to the Letter to the editor from M. H. Haneline and A. L. Rosner. Surg Radiol Anat 2007. [DOI: 10.1007/s00276-007-0183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
19
|
Haneline MT, Rosner AL. Comments about “Atherosclerosis in the vertebral artery: an intrinsic risk factor in the use of spinal manipulation? (2006) Surg Radiol Anat 28:129–134, by Cagnie B, Barbaix E, Vinck E, D’Herde K, Cambier D”. Surg Radiol Anat 2007; 29:185-6; author reply 187. [PMID: 17279321 DOI: 10.1007/s00276-007-0181-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
|
20
|
Dickerman RD, Reynolds A, East JW. The vertebral artery: know the high risk patients. Surg Radiol Anat 2006; 28:539-40. [PMID: 16816889 DOI: 10.1007/s00276-006-0126-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2006] [Accepted: 05/20/2006] [Indexed: 10/24/2022]
|