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Jia X, Zhu Y. Surgical treatment of one traumatic carotid artery dissection: A case report and review of the literature. Medicine (Baltimore) 2024; 103:e39084. [PMID: 39058866 PMCID: PMC11272348 DOI: 10.1097/md.0000000000039084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Dissection of the cervical arteries is the most commonly identified cause of stroke in young patients. This report helps to investigate the etiology, diagnosis, and treatment of cervical artery dissection (CAD). PATIENT CONCERNS A 40-year-old female presented with a 3-week history of right carotid artery dissection due to a fall. The patient was admitted to the local hospital 3 weeks ago with a right neck impingement after a fall, and presented with right neck pain. The local hospital CT scan showed a dissection of the middle segment of the right common carotid artery. DIAGNOSES The patient clinical manifestations and imaging tests confirmed that right carotid artery dissection. INTERVENTIONS Medical treatment with antiplatelet failed, and the CT scan showed progression of dissection. Carotid endarterectomy (CEA) was performed, and the prognosis is good. OUTCOMES This patient was followed up at 1 and 6 months after the operation, CT scan showed the original stenotic vessels returned to standard diameter. LESSONS Diagnosis of CAD mainly depends on clinical manifestations and imaging. we recommend that clinicians can prescribe either anticoagulants or antiplatelet therapy. CAD can be effectively treated by surgical reconstruction, if medical treatment with anticoagulation or antiplatelet fails or if carotid aneurysms and/or high-grade carotid stenosis persisted or have newly developed.
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Affiliation(s)
- Xiaojian Jia
- Department of Vascular Surgery, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yuefeng Zhu
- Department of Vascular Surgery, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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2
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Brown SP. Cervical Spine Manipulation and Causation of Cervical Artery Dissection: A Review of 10 Case Reports. Cureus 2024; 16:e62845. [PMID: 38912081 PMCID: PMC11192210 DOI: 10.7759/cureus.62845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 06/25/2024] Open
Abstract
Recent media coverage of high-profile cases of cervical artery dissection (CAD) has ignited the discussion about the role of cervical spine manipulation (CSM) in causing cervical artery dissection. However, research does not support a causal association between cervical spine manipulation and cervical artery dissection in a healthy cervical spine. The objective of this study was to review the 10 most recent case reports of cervical spine manipulation and cervical artery dissection for convincing evidence of the causation of cervical artery dissection by cervical spine manipulation. Nine of 10 case reports showed no convincing evidence of a causal relationship between cervical spine manipulation and cervical artery dissection. The 10th case report was exceptional as the CSM was contraindicated by pre-existing cervical spine pathology. We conclude that these 10 case reports provide no convincing evidence of the causation of cervical artery dissection by cervical spine manipulation in a healthy cervical spine. One case report demonstrated that cervical spine manipulation can cause cervical artery dissection when performed in the presence of pre-existing cervical spine pathology. Therefore, we conclude that practitioners should exclude cervical spine pathology before performing cervical spine manipulation.
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Affiliation(s)
- Steven P Brown
- Integrative/Complementary Medicine, Brown Chiropractic & Acupuncture, PC, Gilbert, USA
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3
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Makin J, Watson L, Pouliopoulou DV, Laframboise T, Gangloff B, Sidhu R, Sadi J, Parikh P, Gross A, Langevin P, Gillis H, Bobos P. Effectiveness and safety of manual therapy when compared with oral pain medications in patients with neck pain: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2024; 16:86. [PMID: 38627846 PMCID: PMC11020448 DOI: 10.1186/s13102-024-00874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This systematic review and meta-analysis seeks to investigate the effectiveness and safety of manual therapy (MT) interventions compared to oral pain medication in the management of neck pain. METHODS We searched from inception to March 2023, in Cochrane Central Register of Controller Trials (CENTRAL), MEDLINE, EMBASE, Allied and Complementary Medicine (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO) for randomized controlled trials that examined the effect of manual therapy interventions for neck pain when compared to medication in adults with self-reported neck pain, irrespective of radicular findings, specific cause, and associated cervicogenic headaches. We used the Cochrane Risk of Bias 2 tool to assess the potential risk of bias in the included studies, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to grade the quality of the evidence. RESULTS Nine trials (779 participants) were included in the meta-analysis. We found low certainty of evidence that MT interventions may be more effective than oral pain medication in pain reduction in the short-term (Standardized Mean Difference: -0.39; 95% CI -0.66 to -0.11; 8 trials, 676 participants), and moderate certainty of evidence that MT interventions may be more effective than oral pain medication in pain reduction in the long-term (Standardized Mean Difference: - 0.36; 95% CI - 0.55 to - 0.17; 6 trials, 567 participants). We found low certainty evidence that the risk of adverse events may be lower for patients that received MT compared to the ones that received oral pain medication (Risk Ratio: 0.59; 95% CI 0.43 to 0.79; 5 trials, 426 participants). CONCLUSIONS MT may be more effective for people with neck pain in both short and long-term with a better safety profile regarding adverse events when compared to patients receiving oral pain medications. However, we advise caution when interpreting our safety results due to the different level of reporting strategies in place for MT and medication-induced adverse events. Future MT trials should create and adhere to strict reporting strategies with regards to adverse events to help gain a better understanding on the nature of potential MT-induced adverse events and to ensure patient safety. TRIAL REGISTRATION PROSPERO registration number: CRD42023421147.
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Affiliation(s)
- Joshua Makin
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada
| | - Lauren Watson
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada
| | - Dimitra V Pouliopoulou
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, ON, Canada
- Western's Bone and Joint Institute, Collaborative Musculoskeletal Health Research Program, London, ON, Canada
| | - Taylor Laframboise
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada
| | - Bradley Gangloff
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada
| | - Ravinder Sidhu
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada
| | - Jackie Sadi
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada
| | - Pulak Parikh
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada
| | - Anita Gross
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Pierre Langevin
- School of Rehabilitation Sciences, Université Laval, Quebec City, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Physio Interactive, Quebec City, QC, Canada
| | - Heather Gillis
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada
| | - Pavlos Bobos
- Comprehensive Musculoskeletal Field, Advanced Health Care Program, School of Physical Therapy, Western University, London, ON, Canada.
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, ON, Canada.
- Western's Bone and Joint Institute, Collaborative Musculoskeletal Health Research Program, London, ON, Canada.
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Yoshida K, Maeda T, Nitta Y, Suzuki K, Kurita H. A Sudden Unilateral Visual Field Loss in a Recreational Tennis Player: Cervical Internal Carotid Artery Dissection Associated With Low-Impact Sports. Cureus 2024; 16:e59305. [PMID: 38813322 PMCID: PMC11134497 DOI: 10.7759/cureus.59305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
Traumatic cervical internal carotid artery dissection (CICAD) is a rare condition caused by blunt trauma to the neck, often through automobile- or sports-related collisions, assaults, or falls. Herein, we report an unusual case in which engaging in a low-impact sport (tennis) caused CICAD, without a direct injury. A 56-year-old man with hypertension suddenly experienced a visual field loss in his right eye while playing tennis. Carotid echocardiography revealed severe stenosis of the right internal carotid artery (ICA). Angiography revealed severe and irregular stenosis of the right ICA from the bifurcation to the petrous portion, suggesting CICAD. Upon admission, the patient had left upper visual field defects in his right eye and neck pain. Antiplatelet therapy was initiated with prasugrel (3.75 mg/day), with the intent to treat surgically if the stenosis or symptoms progressed. Follow-up angiography and magnetic resonance imaging showed gradual resolution of the stenosis, and the patient was discharged on day 28 with a modified Rankin Scale score of 1. The CICAD should be considered as a diagnosis for neurological symptoms, even in the context of low-impact sports such as tennis. Antithrombotic therapy is a reasonable first-line treatment for stable CICAD.
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Affiliation(s)
- Keijiro Yoshida
- Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, JPN
| | - Takuma Maeda
- Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yusuke Nitta
- Neurosurgery, Tokorozawa Chuo Hospital, Tokorozawa, JPN
| | - Kaima Suzuki
- Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, JPN
| | - Hiroki Kurita
- Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, JPN
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5
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Thomas LC, Holliday E, Attia JR, Levi C. Development of a diagnostic support tool for predicting cervical arterial dissection in primary care. J Man Manip Ther 2024; 32:173-181. [PMID: 37651397 PMCID: PMC10956904 DOI: 10.1080/10669817.2023.2250164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES Cervical arterial dissection (CAD) is an important cause of stroke in young people which may be missed because early features may mimic migraine or a musculoskeletal presentation. The study aimed to develop a diagnostic support tool for early identification of CAD. DESIGN Retrospective observational study. SETTING Tertiary hospital. PARTICIPANTS Radiologically confirmed CAD cases (n = 37), non-CAD stroke cases (n = 20), and healthy controls (n = 100). MAIN OUTCOME MEASURES The presence of CAD is confirmed with imaging. Predictive variables included risk factors and clinical characteristics of CAD. Variables with a p-value <0.2 included in a multivariable model. Predictive utility of the model is assessed by calculating area underthe ROC curve (AUC). RESULTS The model including four variables: age 40-55 years (vs < 40), trauma, recent onset headache, and > 2 neurological features, demonstrated excellent discrimination: AUC of 0.953 (95% CI: 0.916, 0.987). A predictive scoring system (total score/7) identified an optimal threshold of ≥ 3 points, with a sensitivity of 87% and specificity of 79%. CONCLUSIONS The study identified a diagnostic support tool with four variables to predict increased risk of CAD. Validation in a clinical sample is needed to confirm variables and refine descriptors to enable clinicians to efficiently apply the tool.Optimum cutoff scores of ≥ 3/7 points will help identify those in whom CAD should be considered and further investigation instigated. The potential impact of the tool is to improve early recognition of CAD in those with acute headache or neck pain, thereby facilitating more timely medical intervention, preventing inappropriate treatment, and improving patient outcomes.Wordcount: 3195.
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Affiliation(s)
- Lucy Caroline Thomas
- School of Health and Rehabilitation Sciences, University of Queensland, QLD, Australia
- School of Health Sciences, The University of Newcastle, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia
| | - John R. Attia
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia
| | - Christopher Levi
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia
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Kara S, Gutierrez Munoz FG, Eckes J, Abdelmoneim SS, Nedd K. Posterior Inferior Cerebellar Artery Stroke Due to a Severe Right Vertebral Artery Stenosis With a Left Cervical Internal Carotid Artery Dissection: What's Next? Cureus 2024; 16:e55598. [PMID: 38586807 PMCID: PMC10994864 DOI: 10.7759/cureus.55598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Guidelines for the treatment and management of ischemic strokes triggered by stenosis versus dissection are well established. However, the presence of both entities in the same patient, although rare, poses challenges for short- and long-term treatment. Here, we describe the case of a 55-year-old man who presented to the emergency department with a 72-hour history of headache, dizziness, unbalanced gait, nausea, and two episodes of vomiting. Stroke was initially suspected, but the computerized tomography (CT) scan showed no hemorrhage. His magnetic resonance imaging (MRI) showed right inferior cerebellar acute ischemia in the territory of the right posterior inferior cerebellar artery (PICA), with smaller foci of early acute infarcts in the bilateral inferior cerebellum. Furthermore, magnetic resonance angiography (MRA) and CT angiography revealed right vertebral artery stenosis and left cervical internal carotid artery dissection (ICAD). This clinical report describes a rare case of stroke secondary to vertebral artery stenosis with concomitant carotid artery dissection. The treatment course and evolution are presented.
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Affiliation(s)
- Sam Kara
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | | | - Jeremy Eckes
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Sahar S Abdelmoneim
- Department of Internal Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Kester Nedd
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
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Brown SP. Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review. Cureus 2024; 16:e56565. [PMID: 38510520 PMCID: PMC10954208 DOI: 10.7759/cureus.56565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 03/22/2024] Open
Abstract
It has been proposed that cervical spine manipulation (CSM) can cause dissection in healthy cervical arteries, with resultant immediate stroke. However, research does not support a causal association between CSM and cervical artery dissection (CAD) in healthy cervical arteries. The objective of this study was to review the literature to identify plausible mechanisms of causation of immediate stroke by CSM. Immediate stroke is defined as a stroke occurring within seconds or minutes of CSM. Our review found plausible thromboembolic and thrombotic mechanisms of causation of immediate stroke by CSM in the literature. The common premise of these mechanisms is CAD being present before CSM, not occurring as a result of CSM. These mechanisms of causation have clinical and medicolegal implications for physicians performing CSM.
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Affiliation(s)
- Steven P Brown
- Integrative/Complementary Medicine, Brown Chiropractic & Acupuncture, PC, Gilbert, USA
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8
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Long B, Pelletier J, Koyfman A, Bridwell RE. High risk and low prevalence diseases: Spontaneous cervical artery dissection. Am J Emerg Med 2024; 76:55-62. [PMID: 37995524 DOI: 10.1016/j.ajem.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Spontaneous cervical artery dissection (sCAD) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of sCAD, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION sCAD is a condition affecting the carotid or vertebral arteries and occurs as a result of injury and compromise to the arterial wall layers. The dissection most commonly affects the extracranial vessels but may extend intracranially, resulting in subarachnoid hemorrhage. Patients typically present with symptoms due to compression of local structures, and the presentation depends on the vessel affected. The most common symptom is headache and/or neck pain. Signs and symptoms of ischemia may occur, including transient ischemic attack and stroke. There are a variety of risk factors for sCAD, including underlying connective tissue or vascular disorders, and there may be an inciting event involving minimal trauma to the head or neck. Diagnosis includes imaging, most commonly computed tomography angiography of the head and neck. Ultrasound can diagnose sCAD but should not be used to exclude the condition. Treatment includes specialist consultation (neurology and vascular specialist), consideration of thrombolysis in appropriate patients, symptomatic management, and administration of antithrombotic medications. CONCLUSIONS An understanding of sCAD can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
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Trager RJ, Troutner AM, Pikus HJ, Daniels CJ, Dusek JA. Symptoms of Patients With Vertebral Artery Dissection Presenting to Chiropractors: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e51297. [PMID: 38283533 PMCID: PMC10822691 DOI: 10.7759/cureus.51297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Early symptoms of vertebral artery dissection (VAD) may be nonspecific, including neck pain and headache. Neck pain and headache are also common reasons for patients to seek chiropractic care. We hypothesized that neck pain and/or headache would be the most prevalent symptoms among patients with undiagnosed VAD presenting to chiropractors compared to dizziness or other symptoms. We searched PubMed, Ovid, the Index to Chiropractic Literature, Google Scholar, and gray literature through September 2023 for observational studies describing patients aged ≥10 with previously undiagnosed VAD presenting to a chiropractor. Article selection, data extraction, and quality assessment were performed in duplicate. We synthesized the point prevalence of symptoms and other clinical features. We included 10 case reports describing 10 patients (mean age = 37, SD = 7, 60% female). All patients had either neck pain or headache (100%; 95% confidence interval (CI) = 100%-100%). The most prevalent individual symptoms were neck pain (90%; 95% CI = 71%-100%), headache (80%; 95% CI = 55%-100%), visual disturbance (50%; 95% CI = 19%-81%), and dizziness (40%; 95% CI = 10%-70%). The certainty of results was very low due to publication bias. While our findings suggest that neck pain and/or headache are the most prevalent symptoms among patients with undiagnosed VAD visiting a chiropractor, the small sample size and reliance on case reports preclude any definitive conclusions. Further research with larger sample sizes, control groups, and better control of confounders is required to corroborate these results. Chiropractors should be aware of VAD features and refer suspected patients for emergency care.
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Affiliation(s)
- Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, USA
| | - Alyssa M Troutner
- Department of Clinical Education, Southern California University of Health Sciences, Whittier, USA
| | - Harold J Pikus
- Neurosurgery, Upper Valley Neurology Neurosurgery, Lebanon, USA
| | - Clinton J Daniels
- Rehabilitation Care Services, Veterans Affairs Puget Sound Health Care System, Tacoma, USA
| | - Jeffery A Dusek
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA
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de Best RF, Coppieters MW, van Trijffel E, Compter A, Uyttenboogaart M, Bot JC, Castien R, Pool JJ, Cagnie B, Scholten-Peeters GG. Risk assessment of vascular complications following manual therapy and exercise for the cervical region: diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project). J Physiother 2023; 69:260-266. [PMID: 37690959 DOI: 10.1016/j.jphys.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/29/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
QUESTION What is the diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) framework to assess the risk of vascular complications in patients seeking physiotherapy care for neck pain and/or headache? DESIGN Cross-sectional diagnostic accuracy study. PARTICIPANTS One hundred and fifty patients seeking physiotherapy for neck pain and/or headache in primary care. METHODS Nineteen physiotherapists performed the index test according to the IFOMPT framework. Patients were classified as having a high, intermediate or low risk of vascular complications, following manual therapy and/or exercise, derived from the estimated risk of the presence of vascular pathology. The reference test was a consensus medical decision reached by a vascular neurologist and an interventional neurologist, with input from a neuroradiologist. The neurologists had access to clinical data and magnetic resonance imaging of the cervical spine, including an angiogram of the cervical arteries. OUTCOME MEASURES Diagnostic accuracy measures were calculated for 'no contraindication' (ie, the low-risk category) and 'contraindication' (ie, the high-risk and intermediate-risk categories) for manual therapy and/or exercise. Sensitivity, specificity, predictive values, likelihood ratios and the area under the curve were calculated. RESULTS Manual therapy and/or exercise were contraindicated in 54.7% of the patients. The sensitivity of the IFOMPT framework was low (0.50, 95% CI 0.39 to 0.61) and its specificity was moderate (0.63, 95% CI 0.51 to 0.75). The positive and negative likelihood ratios were weak at 1.36 (95% CI 0.93 to 1.99) and 0.79 (95% CI 0.60 to 1.05), respectively. The area under the curve was poor (0.57, 95% CI 0.49 to 0.65). CONCLUSION The IFOMPT framework has poor diagnostic accuracy when compared with a reference standard consisting of a consensus medical decision.
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Affiliation(s)
- Rogier F de Best
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
| | | | - Annette Compter
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost C Bot
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rene Castien
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jan Jm Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Gwendolyne Gm Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
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11
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Whedon JM, Petersen CL, Schoellkopf WJ, Haldeman S, MacKenzie TA, Lurie JD. The association between cervical artery dissection and spinal manipulation among US adults. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3497-3504. [PMID: 37422607 PMCID: PMC10591258 DOI: 10.1007/s00586-023-07844-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/23/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Cervical artery dissection (CeAD), which includes both vertebral artery dissection (VAD) and carotid artery dissection (CAD), is the most serious safety concern associated with cervical spinal manipulation (CSM). We evaluated the association between CSM and CeAD among US adults. METHODS Through analysis of health claims data, we employed a case-control study with matched controls, a case-control design in which controls were diagnosed with ischemic stroke, and a case-crossover design in which recent exposures were compared to exposures in the same case that occurred 6-7 months earlier. We evaluated the association between CeAD and the 3-level exposure, CSM versus office visit for medical evaluation and management (E&M) versus neither, with E&M set as the referent group. RESULTS We identified 2337 VAD cases and 2916 CAD cases. Compared to population controls, VAD cases were 0.17 (95% CI 0.09 to 0.32) times as likely to have received CSM in the previous week as compared to E&M. In other words, E&M was about 5 times more likely than CSM in the previous week in cases, relative to controls. CSM was 2.53 (95% CI 1.71 to 3.68) times as likely as E&M in the previous week among individuals with VAD than among individuals experiencing a stroke without CeAD. In the case-crossover study, CSM was 0.38 (95% CI 0.15 to 0.91) times as likely as E&M in the week before a VAD, relative to 6 months earlier. In other words, E&M was approximately 3 times more likely than CSM in the previous week in cases, relative to controls. Results for the 14-day and 30-day timeframes were similar to those at one week. CONCLUSION Among privately insured US adults, the overall risk of CeAD is very low. Prior receipt of CSM was more likely than E&M among VAD patients as compared to stroke patients. However, for CAD patients as compared to stroke patients, as well as for both VAD and CAD patients in comparison with population controls and in case-crossover analysis, prior receipt of E&M was more likely than CSM.
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Affiliation(s)
- James M Whedon
- Health Services Research, Southern California University of Health Sciences, Whittier, CA, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA.
| | - Curtis L Petersen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Scott Haldeman
- Health Services Research, Southern California University of Health Sciences, Whittier, CA, USA
- Department of Neurology, University of California at Irvine, Irvine, CA, USA
| | - Todd A MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Jon D Lurie
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
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Garrett B, Caulfield T, Musoke R, Murdoch B, Tang X, Lam JST. Demographic and psychometric predictors associated with engagement in risk-associated alternative healthcare behaviours. PLoS One 2023; 18:e0291016. [PMID: 37733748 PMCID: PMC10513319 DOI: 10.1371/journal.pone.0291016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
This paper builds on prior work exploring the use of risk-associated alternative healthcare (RAAH) in Canada. RAAH uptake was surveyed to explore the characteristics of adult RAAH users and the value of established psychometric instruments previously used in alternative healthcare studies in predicting RAAH behaviours: the Control Beliefs Inventory (CBI), the Reward Responsiveness Behavioural Activation System (RBAS) scale, the Positive Attitudes to Science (PAS) scale, the Satisfaction with Orthodox Medicine (SOM) scale, and the brief version of the Susceptibility to Persuasion-II (StP-II-B) scale. Findings suggest RAAH is influenced by gender, age, income, education, employment, chronic illness status, and ethnicity. Engagement in some form of RAAH was common (around 40%) and the most common types of RAAH use reported were physical manipulation and herbal/nutritional supplement use. Other higher-risk AH activities (such as use of toxins and physically invasive procedures) were also reported by about 5% of respondents. The StP-II-B and PAS instruments were predictive of the likelihood of engagement in RAAH behaviours, as illustrated by higher risk tolerance, desire for novelty, positive attitude to advertising and social influence, and positive beliefs about science. The CBI, RBAS, and SOM instruments were not predictive overall. However, the CBI and SOM instruments were predictive of engagement with physical manipulative RAAH activities, while the RBAS was predictive of herbal/nutritional RAAH engagement. These findings can help inform health professionals' understanding of public health-seeking behaviours with respect to risk.
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Affiliation(s)
- Bernie Garrett
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy Caulfield
- Health Law Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Musoke
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Blake Murdoch
- Health Law Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Xuyan Tang
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joyce S. T. Lam
- Pacific Parkinson’s Research Centre, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
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Gorrell LM, Sawatsky A, Edwards WB, Herzog W. Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers. J Man Manip Ther 2023; 31:261-269. [PMID: 36382347 PMCID: PMC10324446 DOI: 10.1080/10669817.2022.2148048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The vertebral artery (VA) may be stretched and subsequently damaged during manual cervical spine manipulation. The objective of this study was to measure VA length changes that occur during cervical spine manipulation and to compare these to the VA failure length. METHODS Piezoelectric ultrasound crystals were implanted along the length of the VA (C1 to C7) and were used to measure length changes during cervical spine manipulation of seven un-embalmed, post-rigor human cadavers. Arteries were then excised, and elongation from arbitrary in-situ head/neck positions to first force (0.1 N) was measured. Following this, VA were stretched (8.33 mm/s) to mechanical failure. Failure was defined as the instance when VA elongation resulted in a decrease in force. RESULTS From arbitrary in-situ head/neck positions, the greatest average VA length change during spinal manipulation was [mean (range)] 5.1% (1.1 to 15.1%). From arbitrary in-situ head/neck positions, arteries were elongated on average 33.5% (4.6 to 84.6%) prior to first force occurrence and 51.3% (16.3 to 105.1%) to failure. Average failure forces were 3.4 N (1.4 to 9.7 N). CONCLUSIONS Measured in arbitrary in-situ head/neck positions, VA were slack. It appears that this slack must be taken up prior to VA experiencing tensile force. During cervical spine manipulations (using cervical spine extension and rotation), arterial length changes remained below that slack length, suggesting that VA elongated but were not stretched during the manipulation. However, in order to answer the question if cervical spine manipulation is safe from a mechanical perspective, the testing performed here needs to be repeated using a defined in-situ head/neck position and take into consideration other structures (e.g. carotid arteries).
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Affiliation(s)
- Lindsay M. Gorrell
- Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist and University of Zürich, Zürich ,Switzerland
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Andrew Sawatsky
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Xie S, Ran Y, Wang X, Zhang Y, Fu Q, Ren Y, Liu J, Teng Z, Cheng J. Diagnostic potential of routine brain MRI and high-resolution, multi-contrast vessel wall imaging in the detection of internal carotid artery dissection. Front Neurol 2023; 14:1165453. [PMID: 37251240 PMCID: PMC10213939 DOI: 10.3389/fneur.2023.1165453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Cervical artery dissection (CAD) is one of the major causes of stroke and most commonly occurs at the site of the extracranial internal carotid artery (ICA). This study aimed to assess the value of routine brain MRI, clinical information, and high-resolution, multi-contrast vessel wall MR imaging (hrVWI) for the timely detection of ICA dissection. Methods A total of 105 patients with CAD and 105 without CAD were recruited for this study. The lesion type in the patients was determined based on images from different modalities, including brain MRI, magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography (DSA), ultrasonography, and hrVWI and clinical information. Each lesion was reviewed to determine the type following a stepwise procedure by referring to (1) brain MRI only; (2) brain MRI and clinical information; (3) hrVWI only; and (4) hrVWI, CTA, DSA, and clinical information. Results Typical clinical presentations of patients with potential CAD include headache, neck pain, and/or Horner's syndrome. Representative imaging signs in the brain MRI included a crescentic or circular iso- or hyperintensity around the lumen, a curvilinear and isointense line crossing the lumen, or aneurysmal vessel dilation. Based on brain MRI alone, 54.3% (57/105) of the patients with CAD were correctly classified, and the accuracy increased to 73.3% (77/105) when clinical information was combined (P < 0.001) with high specificity and low sensitivity. Further analysis showed that hrVWI had the superior capability in detecting CAD, with a sensitivity and a specificity of 95.1% and 97.0%, respectively. Conclusion The combination of brain MRI and clinical information could be used for the diagnosis of CAD; however, hrVWI should be sought for uncertain cases.
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Affiliation(s)
- Shanshan Xie
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qichang Fu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanan Ren
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juanfang Liu
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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15
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Gorrell LM, Brown BT, Engel R, Lystad RP. Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review. BMJ Open 2023; 13:e067526. [PMID: 37142321 PMCID: PMC10163511 DOI: 10.1136/bmjopen-2022-067526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES To describe if there has been a change in the reporting of adverse events associated with spinal manipulation in randomised clinical trials (RCTs) since 2016. DESIGN A systematic literature review. DATA SOURCES Databases were searched from March 2016 to May 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. The following search terms and their derivatives were adapted for each platform: spinal manipulation; chiropractic; osteopathy; physiotherapy; naprapathy; medical manipulation and clinical trial. METHODS Domains of interest (pertaining to adverse events) included: completeness and location of reporting; nomenclature and description; spinal location and practitioner delivering manipulation; methodological quality of the studies and details of the publishing journal. Frequencies and proportions of studies reporting on each of these domains were calculated. Univariable and multivariable logistic regression models were fitted to examine the effect of potential predictors on the likelihood of studies reporting on adverse events. RESULTS There were 5399 records identified by the electronic searches, of which 154 (2.9%) were included in the analysis. Of these, 94 (61.0%) reported on adverse events with only 23.4% providing an explicit description of what constituted an adverse event. Reporting of adverse events in the abstract has increased (n=29, 30.9%) while reporting in the results section has decreased (n=83, 88.3%) over the past 6 years. Spinal manipulation was delivered to 7518 participants in the included studies. No serious adverse events were reported in any of these studies. CONCLUSIONS While the current level of reporting of adverse events associated with spinal manipulation in RCTs has increased since our 2016 publication on the same topic, the level remains low and inconsistent with established standards. As such, it is imperative for authors, journal editors and administrators of clinical trial registries to ensure there is more balanced reporting of both benefits and harms in RCTs involving spinal manipulation.
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Affiliation(s)
- Lindsay M Gorrell
- Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | - Benjamin T Brown
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Roger Engel
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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16
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Arning C. Ultrasound Criteria for Diagnosing Spontaneous Cervical Artery Dissections. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:126-150. [PMID: 36746198 DOI: 10.1055/a-2004-4986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Spontaneous dissection of brain-supplying cervical arteries, which also includes findings after minor injuries, is one of the main causes of ischaemic strokes in young adults. Strokes due to dissection are usually due to arterio-arterial embolism. They are rarely the first symptom of dissection because an intraluminal thrombus must first develop. Therefore, early diagnosis of dissection can contribute to stroke prevention - through immediate therapy with anticoagulants or antiplatelet drugs. This article describes the diagnostic criteria and typical findings of spontaneous dissection, in which no dissecting membrane is to be expected as in aortic dissection. Traumatic dissections following blunt or penetrating injuries also present with different findings. Examiners should be aware of possible differential diagnoses whose ultrasound image may mimic a dissection. A frequently occurring but avoidable cause of misdiagnosis is idiopathic carotidynia. Ultrasound also enables differentiation between dissection and vasculitis or carotid web and detection of normal variants such as fenestration of the vertebral artery. Further possibilities for misdiagnosis may arise in the presence of a variant of the ascending pharyngeal artery or in extracranial vasospasm. The different imaging techniques for the detection of a dissection are complementary, as false-negative findings occur with all techniques; no method serves as the gold standard. In any case, ultrasound can make an important contribution to the detection of a dissection, and it is worth knowing the diagnostic criteria.
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Salehi Omran S. Cervical Artery Dissection. Continuum (Minneap Minn) 2023; 29:540-565. [PMID: 37039409 DOI: 10.1212/con.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Cervical artery dissection is a common cause of stroke in young adults. This article reviews the pathophysiology, etiology and risk factors, evaluation, management, and outcomes of spontaneous cervical artery dissection. LATEST DEVELOPMENTS Cervical artery dissection is believed to be a multifactorial disease, with environmental factors serving as possible triggers in patients who have a genetic predisposition to dissection formation. Cervical artery dissection can cause local symptoms or ischemic events, such as ischemic stroke or transient ischemic attack. Neuroimaging is used to confirm the diagnosis; classic findings include a long tapered arterial stenosis or occlusion, dissecting aneurysm, intimal flap, double lumen, or intramural hematoma. Patients with cervical artery dissection who present with an acute ischemic stroke should be evaluated for IV thrombolysis, endovascular therapy eligibility, or both. Antithrombotic therapy with either anticoagulation or antiplatelet treatment is used to prevent stroke from cervical artery dissection. The risk of recurrent ischemia appears low and is mostly limited to the first two weeks after symptom onset. ESSENTIAL POINTS Cervical artery dissection is a known cause of ischemic strokes. Current data show no difference between the benefits and risks of anticoagulation versus antiplatelet therapy in the acute phase of symptomatic extracranial cervical artery dissection, thereby supporting the recommendation that clinicians can prescribe either treatment. Further research is warranted to better understand the pathophysiology and long-term outcomes of cervical artery dissection.
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18
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Meschia JF. Diagnostic Evaluation of Stroke Etiology. Continuum (Minneap Minn) 2023; 29:412-424. [PMID: 37039402 DOI: 10.1212/con.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Precise therapies require precise diagnoses. This article provides an evidence-based approach to confirming the diagnosis of ischemic stroke, characterizing comorbidities that provide insights into the pathophysiologic mechanisms of stroke, and identifying targets for treatment to optimize the prevention of recurrent stroke. LATEST DEVELOPMENTS Identifying the presence of patent foramen ovale, intermittent atrial fibrillation, and unstable plaque is now routinely included in an increasingly nuanced workup in patients with stroke, even as ongoing trials seek to clarify the best approaches for treating these and other comorbidities. Multicenter trials have demonstrated the therapeutic utility of patent foramen ovale closure in select patients younger than age 60 years. Insertable cardiac monitors detect atrial fibrillation lasting more than 30 seconds in about one in ten patients monitored for 12 months following a stroke. MRI of carotid plaque can detect unstable plaque at risk of being a source of cerebral embolism. ESSENTIAL POINTS To optimize the prevention of recurrent stroke, it is important to consider pathologies of intracranial and extracranial blood vessels and of cardiac structure and rhythm as well as other inherited or systemic causes of stroke. Some aspects of the stroke workup should be done routinely, while other components will depend on the clinical circumstances and preliminary testing results.
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19
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Hosoki S, Fukuda-Doi M, Miwa K, Yoshimura S, Morita Y, Chiba T, Noda K, Yamaguchi Y, Ikenouchi H, Makita N, Mizoguchi T, Nakamura Y, Satow T, Kataoka H, Toyoda K, Ihara M, Koga M. Sequential detection rates of intramural hematoma for diagnosing spontaneous intracranial artery dissection. Eur J Neurol 2023; 30:1320-1326. [PMID: 36695192 DOI: 10.1111/ene.15715] [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: 11/06/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Spontaneous intracranial artery dissection (IAD) can be definitively diagnosed by detecting intramural hematoma (IMH) on arterial wall imaging. However, evidence of a time-dependent natural history for the development of radiological findings is lacking. Therefore, this study aimed to determine when imaging detects IAD. METHODS We obtained data from our cohort databases between March 2011 and August 2018 on consecutive patients who had definite, probable, or possible IAD based on the multidisciplinary expert consensus criteria. We assessed IMH on initial and follow-up high-resolution three-dimensional T1-weighted imaging (HR-3D-T1WI). We retrospectively investigated the association between IMH detection and days from symptom onset to initial HR-3D-T1WI and compared the IMH detection rate with other definitive diagnostic arterial dissection findings. RESULTS We analyzed 106 patients (mean age = 51 ± 13 years, 31 women) with at least initial HR-3D-T1WI data. The final diagnoses were definite, probable, and possible IAD in 83, 18, and 5 patients, respectively. IMHs were observed in 63 patients (59%, 95% confidence interval [CI] = 49%-69%). Overall IMH detection rate was 55% (95% CI = 45%-64%), 20% (95% CI = 3%-60%), 40% (95% CI = 21%-64%), and 50% (95% CI = 37%-63%) on the initial HR-3D-T1WI and Days 3, 7, and 13, respectively. Among 68 patients evaluated with digital subtraction angiography and HR-3D-T1WI, IMH was confirmed more frequently than other definitive diagnostic arterial dissection findings. CONCLUSIONS The overall IMH detection rate on HR-3D-T1WI was >50% and peaked in 1-2 weeks. IMH was a frequently detectable finding for the diagnosis of IAD compared to other radiological findings.
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Affiliation(s)
- Satoshi Hosoki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mayumi Fukuda-Doi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tetsuya Chiba
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kotaro Noda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hajime Ikenouchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naoki Makita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tadataka Mizoguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Nakamura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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20
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Whedon JM, Petersen CL, Li Z, Schoelkopf WJ, Haldeman S, MacKenzie TA, Lurie JD. Association between cervical artery dissection and spinal manipulative therapy -a medicare claims analysis. BMC Geriatr 2022; 22:917. [PMID: 36447166 PMCID: PMC9710172 DOI: 10.1186/s12877-022-03495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical artery dissection and subsequent ischemic stroke is the most serious safety concern associated with cervical spinal manipulation. METHODS We evaluated the association between cervical spinal manipulation and cervical artery dissection among older Medicare beneficiaries in the United States. We employed case-control and case-crossover designs in the analysis of claims data for individuals aged 65+, continuously enrolled in Medicare Part A (covering hospitalizations) and Part B (covering outpatient encounters) for at least two consecutive years during 2007-2015. The primary exposure was cervical spinal manipulation; the secondary exposure was a clinical encounter for evaluation and management for neck pain or headache. We created a 3-level categorical variable, (1) any cervical spinal manipulation, 2) evaluation and management but no cervical spinal manipulation and (3) neither cervical spinal manipulation nor evaluation and management. The primary outcomes were occurrence of cervical artery dissection, either (1) vertebral artery dissection or (2) carotid artery dissection. The cases had a new primary diagnosis on at least one inpatient hospital claim or primary/secondary diagnosis for outpatient claims on at least two separate days. Cases were compared to 3 different control groups: (1) matched population controls having at least one claim in the same year as the case; (2) ischemic stroke controls without cervical artery dissection; and (3) case-crossover analysis comparing cases to themselves in the time period 6-7 months prior to their cervical artery dissection. We made each comparison across three different time frames: up to (1) 7 days; (2) 14 days; and (3) 30 days prior to index event. RESULTS The odds of cervical spinal manipulation versus evaluation and management did not significantly differ between vertebral artery dissection cases and any of the control groups at any of the timepoints (ORs 0.84 to 1.88; p > 0.05). Results for carotid artery dissection cases were similar. CONCLUSION Among Medicare beneficiaries aged 65 and older who received cervical spinal manipulation, the risk of cervical artery dissection is no greater than that among control groups.
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Affiliation(s)
- James M Whedon
- Health Services Research, Southern California University of Health Sciences, 16200 Amber Valley Drive, 90604, Whittier, CA, USA.
| | - Curtis L Petersen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Zhongze Li
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Scott Haldeman
- Department of Neurology, University of California at Irvine, Irvine, CA, USA
| | - Todd A MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Jon D Lurie
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
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Keser Z, Chiang CC, Benson JC, Pezzini A, Lanzino G. Cervical Artery Dissections: Etiopathogenesis and Management. Vasc Health Risk Manag 2022; 18:685-700. [PMID: 36082197 PMCID: PMC9447449 DOI: 10.2147/vhrm.s362844] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65-95%), TIA/ischemic stroke (>50%), and partial Horner's syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3-9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
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22
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Identification of Cervical Artery Dissections: Imaging Strategies and Literature Review. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Arning C, Hanke-Arning K, Eckert B. The Clinical Features of Dissection of the Cervical Brain-Supplying Arteries. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:581-587. [PMID: 35734920 PMCID: PMC9749844 DOI: 10.3238/arztebl.m2022.0238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Dissections of the cervical brain-supplying arteries are a leading cause of ischemic stroke in young adults, with an annual incidence of 2.5-3 / 100 000 for carotid artery dissection and 1-1.5 / 100 000 for vertebral artery dissection. It can be assumed that many cases go unreported. We present the clinical features here to help physicians diagnose this disease entity as rapidly as possible. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed. RESULTS Spontaneous dissection of the internal carotid or vertebral artery is characterized by a hematoma in the vessel wall. It often arises in connection with minor injuries; underlying weakness of the arterial wall (possibly only temporary) may be a predisposing factor. Acute unilateral pain is the main presenting symptom. In internal carotid dissection, the site of the pain is temporal in 46% of cases, and frontal in 19%; in vertebral artery dissection, it is nuchal and occipital in 80%. Pain and local findings, such as Horner syndrome, are generally present from the beginning, while stroke may arise only after a latency of hours to days. If the diagnosis is made early with MRI, CT, or ultrasound, and anticoagulation or antiplatelet drugs can help prevent a stroke, yet none of these methods can detect all cases. Recurrent dissection is rare, except in patients with connective tissue diseases such as Ehlers-Danlos syndrome or fibromuscular dysplasia. Spontaneous dissection of the great vessels of the neck must be differentiated from aortic dissection spreading to the supra-aortic vessels and from traumatic dissection due to blunt or penetrating vascular trauma. CONCLUSION Dissection of the cervical brain-supplying vessels is not always revealed by the imaging methods that are used to detect it. Stroke prevention thus depends on the physician's being aware of the symptoms and signs of this disease entity, so that early diagnosis can be followed by appropriate treatment.
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Affiliation(s)
- Christian Arning
- Praxis Neurologie und Neuro-Ultraschall, Hamburg,*Facharzt für Neurologie und Psychiatrie Moorhof 2d, D-22399 Hamburg, Germany
| | | | - Bernd Eckert
- Department of Neuroradiology, Asklepios Klinik Altona, Hamburg
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Russell BS, Keller M, Wynd SE, Hosek RS, Owens EF, Hoiriis KT. Angular Kinematics of Chiropractic Supine Cervical Spine Manipulation: Rotational Measures and Comparisons to Doctor and Recipient Perceptions. J Manipulative Physiol Ther 2022; 45:497-507. [PMID: 36922054 DOI: 10.1016/j.jmpt.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/20/2022] [Accepted: 12/01/2022] [Indexed: 03/17/2023]
Abstract
OBJECTIVES The primary purposes of this study were to measure axial rotation during supine cervical spinal manipulative therapy (cSMT) and to record recipients' and doctors' perceptions of rotational magnitudes. METHODS Experienced doctors of chiropractic (DCs) provided supine cSMT and acted as recipients of cSMT. Participants who received SMT wore inertial measurement units attached to the forehead and sternum for motion capture. Afterward, recipients and DCs completed questionnaires asking about their perceptions of motion. Data were analyzed for magnitudes of axial rotation at peak thrust and correlations with patient and doctor perceptions. Secondary analyses included angular velocity, angular acceleration, and other kinematic variables. RESULTS We recorded 23 SMT events with 14 DCs. Rotation at thrust peaks averaged 32.4° (17.4°). Doctors' and recipients' perceptions of rotation were higher than measured values 45% and 50% of the time, respectively. Maximum angular velocity and acceleration averaged 221.9°/s (124.9) and 4786.5°/s2 (2456.6), respectively. We found no correlation between perceptions and velocity or acceleration; doctors' perceptions had an inverse correlation with measurements. CONCLUSION On average, we found rotation during supine cSMT to be 32°. Both DCs and SMT recipients overestimated rotation compared with actual measurements. These factors should be considered in discussions of rotation and SMT.
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Affiliation(s)
- Brent S Russell
- Life University Center for Chiropractic Research, Atlanta, Georgia.
| | - Mackenzie Keller
- Life University Center for Chiropractic Research, Atlanta, Georgia
| | - Shari E Wynd
- Department of Foundational Sciences, Texas Chiropractic College, Pasadena, Texas
| | - Ronald S Hosek
- Life University Center for Chiropractic Research, Atlanta, Georgia
| | - Edward F Owens
- Life University Center for Chiropractic Research, Atlanta, Georgia
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Yan Y, Lu Z, Ding Y, Pu J, Hu C, Teng Z, Hui P. Predictors of ischemic events in patients with unilateral extracranial vertebral artery dissection: A single-center exploratory study. Front Neurol 2022; 13:939001. [PMID: 35968293 PMCID: PMC9366300 DOI: 10.3389/fneur.2022.939001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Extracranial vertebral artery dissection (EVAD) is one of the main causes of stroke in young and middle-aged patients. However, the diagnosis is challenging. This study aimed to identify the characteristics of EVAD on color duplex ultrasonography (CDU) and high-resolution magnetic resonance imaging (hrMRI), hoping to improve the accuracy and determine the relative contribution of vessel findings and clinical factors to acute ischemic events. Methods Patients with unilateral EVAD were recruited and divided into ischemia and non-ischemia groups. Clinical features of patients and the lesion location; a variety of signs which indicate dissection, including the presence of an intimal flap, double lumen, intramural hematoma, dissecting aneurysm, intraluminal thrombus, and irregular lumen; and other quantitative parameters of each dissected segment on CDU and hrMRI were reviewed, respectively. Multiple logistic regression was performed to explore the association between clinical, imaging characteristics, and ischemic events in patients with unilateral EVAD. Results Ninety-six patients with unilateral EVAD who met the inclusion criteria were enrolled during a six-year period. Overall, 41 cases (42.7%) were confirmed as ischemic stroke (n = 40) or transient ischemic attack (n = 1) during the 48 h after the onset of symptoms. Men, infections during the last week, and smoking were more common in the ischemia group. Intraluminal thrombus and occlusion on CDU were more prevalent in patients with cerebral ischemia than in those without (36.6 vs. 5.5%; p < 0.001, and 39.0 vs. 9.1%; p = 0.001, respectively). On hrMRI, intraluminal thrombus and occlusion were also more frequent in the ischemia group than in the non-ischemia group (34.1 vs. 5.5%; p < 0.001, and 34.1 vs. 9.1%; p = 0.003, respectively). In addition, lesion length on hrMRI was significantly longer for patients with ischemia (81.5 ± 41.7 vs. 64.7 ± 30.8 mm; p = 0.025). In multivariable logistic regression analysis, male gender, infections during the last week, and the presence of intraluminal thrombus on CDU and hrMRI were independently associated with acute ischemic events. Conclusion Male sex, infections during the last week, and the presence of intraluminal thrombus due to dissection are associated with an increased risk of ischemic events in patients with unilateral EVAD.
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Affiliation(s)
- Yanhong Yan
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziwei Lu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yafang Ding
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhong Pu
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Zhongzhao Teng
| | - Pinjing Hui
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
- Pinjing Hui
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The EZ, Lin NN, Chan CJ, Loon JCW, Tan BYQ, Seet CSR, Teoh HL, Vijayan J, Yeo LLL. Antiplatelets or anticoagulants? Secondary prevention in cervical artery dissection: an updated meta-analysis. Neurol Res Pract 2022; 4:23. [PMID: 35692052 PMCID: PMC9190132 DOI: 10.1186/s42466-022-00188-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Extracranial artery dissection involving either internal carotid artery or vertebral artery is a major cause of stroke in adults under 50 years of age. There is no conclusive evidence whether antiplatelets or anticoagulants are better suited in the treatment of extracranial artery dissection. OBJECTIVES To determine whether antiplatelets or anticoagulants have advantage over the other in the treatment of extracranial artery dissection for secondary prevention of recurrent ischemic events or death. METHODS Present meta-analysis followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement. Database search was done in Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov from inception to May 2021 using pre-defined search strategy. Additional studies were identified from reference lists from included studies, reviews and previous meta-analyses. Outcome measures were ischaemic stroke, ischaemic stroke or transient ischaemic attack (TIA), and death. RESULTS Two RCTs and 64 observational studies were included in the meta-analysis. While the outcome measures of stroke, stroke or TIA and death were numerically higher with antiplatelet use, there were no statistically significant differences between antiplatelets and anticoagulants. CONCLUSION We found no significant difference between antiplatelet and anticoagulation treatment after extracranial artery dissection. The choice of treatment should be tailored to individual cases.
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Affiliation(s)
- Ei Zune The
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.
- University Hospitals of Leicester NHS Trust, Leicester, UK.
- Leicester General Hospital, Gwendolen Rd, Leicester, LE5 4PW, UK.
| | | | | | | | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Chee Seong Raymond Seet
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Joy Vijayan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Leong Litt Leonard Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
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Gorrell LM, Kuntze G, Ronsky JL, Carter R, Symons B, Triano JJ, Herzog W. Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation. Chiropr Man Therap 2022; 30:28. [PMID: 35650649 PMCID: PMC9158147 DOI: 10.1186/s12998-022-00438-0] [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: 10/25/2021] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background Cervical spine manipulation (CSM) is a frequently used treatment for neck pain. Despite its demonstrated efficacy, concerns regarding the potential of stretch damage to vertebral arteries (VA) during CSM remain. The purpose of this study was to quantify the angular displacements of the head relative to the sternum and the associated VA length changes during the thrust phase of CSM. Methods Rotation and lateral flexion CSM procedures were delivered bilaterally from C1 to C7 to three male cadaveric donors (Jan 2016–Dec 2019). For each CSM the force–time profile was recorded using a thin, flexible pressure pad (100–200 Hz), to determine the timing of the thrust. Three dimensional displacements of the head relative to the sternum were recorded using an eight-camera motion analysis system (120–240 Hz) and angular displacements of the head relative to the sternum were computed in Matlab. Positive kinematic values indicate flexion, left lateral flexion, and left rotation. Ipsilateral refers to the same side as the clinician's contact and contralateral, the opposite. Length changes of the VA were recorded using eight piezoelectric ultrasound crystals (260–557 Hz), inserted along the entire vessel. VA length changes were calculated as D = (L1 − L0)/L0, where L0 = length of the whole VA (sum of segmental lengths) or the V3 segment at CSM thrust onset; L1 = whole VA or V3 length at peak force during the CSM thrust. Results Irrespective of the type of CSM, the side or level of CSM application, angular displacements of the head and associated VA length changes during the thrust phase of CSM were small. VA length changes during the thrust phase were largest with ipsilateral rotation CSM (producing contralateral head rotation): [mean ± SD (range)] whole artery [1.3 ± 1.0 (− 0.4 to 3.3%)]; and V3 segment [2.6 ± 3.6 (− 0.4 to 11.6%)]. Conclusions Mean head angular displacements and VA length changes were small during CSM thrusts. Of the four different CSM measured, mean VA length changes were largest during rotation procedures. This suggests that if clinicians wish to limit VA length changes during the thrust phase of CSM, consideration should be given to the type of CSM used.
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Affiliation(s)
- Lindsay M Gorrell
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada. .,Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist and University of Zürich, Zurich, Switzerland.
| | - Gregor Kuntze
- Sports Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Janet L Ronsky
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada
| | | | | | - John J Triano
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Jiang Y, Di R, Lu G, Huang L, Wan H, Ge L, Zhang X. Long-Term Outcomes of Stenting on Non-Acute Phase Extracranial Supra-Aortic Dissections. J Korean Neurosurg Soc 2022; 65:422-429. [PMID: 35462523 PMCID: PMC9082125 DOI: 10.3340/jkns.2021.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Methods Results Conclusion
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Cervical Spine Manipulations: Role of Diagnostic Procedures, Effectiveness, and Safety from a Rehabilitation and Forensic Medicine Perspective: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12051056. [PMID: 35626212 PMCID: PMC9139983 DOI: 10.3390/diagnostics12051056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Cervical spine manipulations (CSM) have been performed for centuries and are a widely practiced intervention to manage cervical spine musculoskeletal disorders. We aimed to perform an overview of the literature concerning the effects and the adverse events of CSM in the Physical and Rehabilitation Medicine (PRM) field with a forensic medicine perspective. Methods: A search in the scientific literature (PubMed, Google Scholar, PEDro and Cochrane) was carried out from inception until October 2020. Results: Fourteen articles were included in this narrative summary. The possible development of side effects requires a careful mandatory balance of benefits and risks even when there is an indication for this approach. Moreover, a qualified professional is essential to perform CSM–a non-invasive therapeutic procedure that can be potentially harmful. Conclusions: In conclusion, it is essential to perform the diagnosis, to treat, and to manage complications within the PRM field, both for the reduction of malpractice claims and, most importantly, for the safety of the patient.
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Keser Z, Meschia JF, Lanzino G. Craniocervical Artery Dissections: A Concise Review for Clinicians. Mayo Clin Proc 2022; 97:777-783. [PMID: 35379423 DOI: 10.1016/j.mayocp.2022.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
Craniocervical artery dissection (CAD), although uncommon, can affect the young and lead to devastating complications, including stroke and subarachnoid hemorrhage. It starts with a tear in the intima of a vessel with subsequent formation of an intramural hematoma. Most CAD occurs spontaneously or after minor trauma. Patients with CAD may exhibit isolated symptoms of an underlying subclinical connective tissue disorder or have a clinically diagnosed connective tissue disorder. Emergent evaluation and computed tomography angiography or magnetic resonance imaging/angiography of the head and neck are required to screen for and to diagnose CAD. Carotid ultrasound is not recommended as an initial test because of limited anatomic windows; diagnostic catheter-based angiography is reserved for atypical cases or acutely if severe neurologic deficits are present. Patients with CAD can present with focal neurologic deficits due to ischemia (thromboembolism or arterial occlusion) or subarachnoid hemorrhage (pseudoaneurysm formation and rupture). Also common are local symptoms, such as head and neck pain, pulsatile tinnitus, Horner syndrome, and cranial neuropathy, or cervical radiculopathy from mass effect. Acute management of transient ischemic attack/stroke in CAD is not different from the management of ischemic stroke of other causes. Patients with CAD need long-term antithrombotic therapy for secondary stroke prevention. Anticoagulation or dual antiplatelet therapy followed by single antiplatelet therapy is recommended for extracranial CAD and antiplatelet therapy for intracranial CAD. Recurrent ischemic events and dissections are rare and typically occur early. Patients with CAD should avoid deep neck massage or chiropractic neck manipulation involving sudden excessive, forced neck movements.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN.
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Xu D, Wu Y, Li J, Xing S, Chen H, Chen X, Tan Y, Zhou K, Zhang G, Zhang J. Retrospective Comparative Analysis of Clinical and Imaging Features of Craniocervical Artery Dissection: Spontaneous CAD vs. Minor Traumatic CAD. Front Neurol 2022; 13:836997. [PMID: 35401425 PMCID: PMC8993592 DOI: 10.3389/fneur.2022.836997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Craniocervical artery dissection (CAD) is the most common cause of ischemic stroke in young adults. The etiologies of CAD can be classified into three types, such as spontaneous (sCAD), minor traumatic (mtCAD), and genetic origin. Recent studies indicated that clinical presentations and imaging features could guide management and inform prognosis. This retrospective analysis sought to compare the clinical and imaging features of sCAD vs. mtCAD in providing evidence-based advice on medical treatment, functional rehabilitation, secondary stroke prevention, and prognosis, ultimately formulating clinical guidelines in managing CAD. Methods In total, 148 patients with CAD were identified from the medical records database and subdivided into sCAD and mtCAD based on the clinical presentations and imaging features. A retrospective comparative analysis was performed according to their clinical presentations and imaging features. Results Patients with mtCAD are significantly younger than sCAD with 120 cases of sCAD average aged 43.61 ± 12.75, while 28 cases of mtCAD average aged 35.68 ± 14.54. Patients with mtCAD had more cases of neck pain compared to sCAD. Patients with mtCAD had more cases of CAD at extracranial locations compared to sCAD. Patients with mtCAD had more cases of multiple site dissection compared to sCAD. Double lumen and intramural haematoma are the most common imaging findings with mtCAD patients having statistical significantly more cases of intramural haematoma and long tapering stenosis. Conclusion Patients with mtCAD were presented at a much younger age with symptoms of neck pain compared to sCAD. Patients with mtCAD predominantly presented at extracranial sites with more prominent features of multiple site dissection, intramural haematoma, and long tapering stenosis. These clinical and imaging features can translate into clinical practice guidelines for patients with CAD to improve the optimal functional outcome and reduce both morbidity and mortality.
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Affiliation(s)
- Dan Xu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
- Curtin Medical School/Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Medical Education and General Practice, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongjun Wu
- Department of Neurology, First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Jingjing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Shihui Xing
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Hongbing Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Xinran Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yan Tan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Kun Zhou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Guofen Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
- *Correspondence: Jian Zhang
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Diana F, Frauenfelder G, Saponiero R, Iaconetta G, Romano DG. Endovascular Flow diversion in cervical internal carotid artery dissections. World Neurosurg 2022; 162:10. [DOI: 10.1016/j.wneu.2022.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Pikus HJ. Letter: Traumatic and Spontaneous Vertebral Artery Dissections: An Analysis of Tertiary-Center 310 Patient Cohort. Oper Neurosurg (Hagerstown) 2022; 22:e186. [PMID: 35147586 DOI: 10.1227/ons.0000000000000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Harold J Pikus
- Upper Valley Neurology Neurosurgery, Lebanon, New Hampshire, USA
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Ishida T, Sakata H, Ezura M, Osawa S, Saito A, Tominaga T. Rescue of distally placed stents in the setting of internal carotid artery dissection: A report of 2 cases with mechanistic insights. Clin Neurol Neurosurg 2022; 214:107174. [DOI: 10.1016/j.clineuro.2022.107174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/03/2022]
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Pingree GM, Fleming C, Reavey-Cantwell J, Coelho DH. Neurosurgical Causes of Pulsatile Tinnitus: Contemporary Update. Neurosurgery 2022; 90:161-169. [PMID: 34995248 DOI: 10.1227/neu.0000000000001778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
Traditionally in the domain of the otolaryngologist, pulsatile tinnitus (PT) has become increasingly relevant to neurosurgeons. PT may prove to be a harbinger of life-threatening pathology; however, often, it is a marker of a more benign process. Irrespectively, the neurosurgeon should be familiar with the many potential etiologies of this unique and challenging patient population. In this review, we discuss the myriad causes of PT, categorized by pulse-phase rhythmicity.
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Affiliation(s)
- Graham M Pingree
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Charles Fleming
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - John Reavey-Cantwell
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Daniel H Coelho
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Thomas LC, Seth T, Der A, Ho K, Eide L, Roenaas S, Treleaven J. Improving the recognition of cervical arterial dissection in clinical practice: investigation of a five criteria diagnostic support tool. Physiother Theory Pract 2022; 39:1297-1304. [PMID: 35100949 DOI: 10.1080/09593985.2022.2035033] [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: 10/19/2022]
Abstract
BACKGROUND Cervical arterial dissection (CeAD) is a serious condition that can mimic a musculoskeletal condition. A diagnostic tool using five key criteria could help prompt early medical referral, but these criteria may occur in healthy people or benign neck pain/headache. OBJECTIVE To determine the frequency of CeAD criteria in healthy individuals and those with neck pain/headache, and identify refinements needed to improve specificity. METHODS An interview and neurological screen to identify the presence of the five criteria was conducted. Definitions were refined and the frequency of the modified criteria in each individual was determined. The criteria were re-administered using data from 37 CeAD cases of the derivation cohort, to examine how the modifications impact sensitivity of the tool. RESULTS One hundred healthy and 20 participants with neck pain/headache were interviewed. Most participants had ≤ 2 criteria, mainly age or trauma, 3% had 3 criteria, but had migraine or resolving symptoms. None had >3. Modifications to definitions were needed to improve potential specificity of the tool (96.7%). Changes did not impact sensitivity of the tool (81%). Further refinements may be required. CONCLUSIONS Strictly defined CeAD criteria may assist in identifying when to refer, when to wait and monitor, or when management can proceed. Trialing the tool in those with migraine and in emergency departments to calculate risk scores is recommended.
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Affiliation(s)
- Lucy C Thomas
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Trent Seth
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Andrew Der
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Ken Ho
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Lene Eide
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Stine Roenaas
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
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Vertebral artery dissection after-and also before-chirotherapy. J Neurol 2022; 269:3353-3354. [PMID: 35013787 DOI: 10.1007/s00415-022-10964-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
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Piening K, Piening NM, Chiou A. Internal carotid artery dissection following self-manipulation: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221122451. [PMID: 36090533 PMCID: PMC9459454 DOI: 10.1177/2050313x221122451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
Arterial dissections are a common cause of stroke in young patients. Dissection occurs
when the structure of the arterial wall is compromised, allowing blood to collect between
layers as an intramural hematoma. Symptoms of cervical artery dissection may include pain,
Horner syndrome, cranial and cervical neuropathies, and pulsatile tinnitus. Treatment
varies depending on the severity of symptoms but generally includes anticoagulation with
surgical therapy reserved for patients with progressive neurologic symptoms or symptom
recurrence while on maximum medical therapy. Here, we present the case of a traumatic
internal carotid artery dissection with significant narrowing of the artery in a healthy
26-year-old female after self-manipulation of the neck. She developed Horner syndrome
secondary to her dissection. Our patient was initially treated with anticoagulation and
transitioned to clopidogrel and atorvastatin for outpatient treatment. Six-month follow-up
computed tomography angiography showed complete resolution of her dissection. She had
overall significant improvement in her symptoms with only mild residual ptosis on the
follow-up examination. While the presentation of a patient with neurologic sequelae from a
cervical artery dissection causing stroke is a well-known phenomenon, the mechanical cause
in this particular case is rare. There have been several case reports in the literature
detailing cervical artery dissections following cervical manipulative therapy by trained
professionals (i.e. chiropractors, physical therapists, osteopathic physicians) but none
occurring from self-manipulation of the neck. This case report details successful
treatment of a rare case of internal carotid dissection following self-manipulation with
appropriate medical therapy.
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Affiliation(s)
- Kurt Piening
- Department of Surgery, The University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Nicholas M Piening
- Department of Surgery, The University of Illinois College of Medicine Peoria, Peoria, IL, USA
| | - Andy Chiou
- Department of Surgery, The University of Illinois College of Medicine Peoria, Peoria, IL, USA
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Chen Y, Mofatteh M, Nguyen TN, Wellington J, Wei W, Liang W, Chen G, Hu Z, Ouyang K, Yang S. Carotid Artery Dissection and Ischemic Stroke Following Cervical Chiropractic Manipulation: Two Case Reports. Vasc Endovascular Surg 2021; 56:303-307. [PMID: 34971321 DOI: 10.1177/15385744211072660] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Patients can be at risk of carotid artery dissection and ischemic stroke after cervical chiropractic manipulation. However, such risks are rarely reported and raising awareness can increase the safety of chiropractic manipulations. CASE REPORT We present two middle-aged patients with carotid artery dissection leading to ischemic stroke after receiving chiropractic manipulation in Foshan, Guangdong Province, China. Both patients had new-onset pain in their necks after receiving chiropractic manipulations. Excess physical force during chiropractic manipulation may present a risk to patients. Patient was administered with recombinant tissue plasminogen activator after radiological diagnoses. They were prescribed 100 mg and clopidogrel 75 mg daily for 3 months as dual antiplatelet therapy. There were no complications over the follow-up period. CONCLUSION These cases suggest that dissection of the carotid artery can occur as the result of chiropractic manipulations. Patients should be diagnosed and treated early to achieve positive outcomes. The safety of chiropractic manipulations should be increased by raising awareness about the potential risks.
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Affiliation(s)
- Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Thanh N Nguyen
- Department of Neurology, Radiology, 12259Boston University School of Medicine, Boston, MA, USA
| | | | - Wenlong Wei
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Wenjun Liang
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Gan Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Zhaohui Hu
- Medical Department and Neurosurgery Department, Foshan Sanshui District People's Hospital, Foshan, China
| | - Kexun Ouyang
- Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Shuiquan Yang
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
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Liu Y, Li S, Wu Y, Wu F, Chang Y, Li H, Jia X, Saba L, Ji X, Yang Q. The Added Value of Vessel Wall MRI in the Detection of Intraluminal Thrombus in Patients Suspected of Craniocervical Artery Dissection. Aging Dis 2021; 12:2140-2150. [PMID: 34881091 PMCID: PMC8612619 DOI: 10.14336/ad.2021.0502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/02/2021] [Indexed: 11/12/2022] Open
Abstract
Patients with craniocervical artery dissection (CCAD) have a high short-term risk of ischemic stroke, which is frequently associated with thromboembolism. Previous studies have demonstrated the utility of three-dimensional vessel wall MR imaging (3D-VWMRI) in the diagnosis of dissection. Few have investigated the value of 3D-VWMRI in the detection of intraluminal thrombus. The purpose of the current study was to evaluate the added value of 3D-VWMRI for thrombus identification in patients suspected of CCAD. One hundred and four patients (mean age, 44.2 years ± 13.2) suspected of CCAD and scheduled for digital subtraction angiography (DSA) were prospectively enrolled in the study and underwent VWMRI examination. The diagnostic performance of 3D-VWMRI for CCAD was evaluated using receiver operating characteristic (ROC) analysis with the final diagnosis results as the reference. The presence/absence of intraluminal thrombus on 3D-VWMRI/DSA was independently determined. The sensitivity and specificity of 3D-VWMRI for intraluminal thrombus detection were assessed with DSA serving as the reference. The odds ratio (OR) was used to evaluate the correlation between thrombus presented on 3D-VWMRI/DSA and ischemic stroke. The 3D-VWMRI had high sensitivity (90.0%) and specificity (94.3%) in identifying arteries with CCAD. The area under the ROC curve was 0.96. With DSA as the reference, the sensitivity and accuracy of 3D-VWMRI for the detection of intraluminal thrombus were 97.4% and 79.0%, respectively. An intraluminal thrombus present on 3D-VWMRI was strongly associated with a territorial ischemic stroke (OR: 30.0; 95% confidence interval: 9.1-98.4; P < .001). In conclusion, 3D-VWMRI with a 3.0-T MR system had a high diagnostic performance for CCAD and offered added value for detecting intraluminal thrombus.
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Affiliation(s)
- Yuehong Liu
- 1Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,2Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sijie Li
- 3Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ye Wu
- 2Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fang Wu
- 2Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Chang
- 4Department of Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haibin Li
- 5Department of Epidemiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiuqin Jia
- 1Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Luca Saba
- 6Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Polo di Monserrato SS 554, Monserrato, Cagliari, Italy
| | - Xunming Ji
- 3Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- 1Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,7Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China.,8Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China
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Han CY, Long SM, Parikh NS, Phillips CD, Obayemi A, Yu VX, Banuchi V. Impingement of the Thyroid Cartilage on the Carotid Causing Clicking Larynx Syndrome and Stroke. Laryngoscope 2021; 132:1410-1413. [PMID: 34825720 DOI: 10.1002/lary.29956] [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: 09/27/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022]
Abstract
We present the case of a patient with a recent history of ischemic stroke who presented with clicking larynx syndrome, a condition in which clicking noises in the larynx can be provoked by movement of the head and neck. Diagnostic imaging revealed unusual development and posterior angulation of the superior horn of the thyroid cartilage that potentially was causing trauma to the left common carotid artery. We deduced that symptomatic impingement of the carotid artery by the thyroid cartilage was not only the cause of the patient's clicking larynx syndrome, but also suspected to be the cause of her prior strokes due to repetitive trauma resulting in thrombus. The patient was managed surgically with thyroplasty and transcervical resection of the left greater cornu of the thyroid cartilage with resolution of her symptoms. Anatomical displacement of the thyroid cartilage can manifest as clicking larynx syndrome as well as cause mechanical injury to the carotid artery, resulting in turbulent flow, possible thrombosis, and stroke. Laryngoscope, 2021.
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Affiliation(s)
| | - Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Neal S Parikh
- Department of Neurology, Weill Cornell Medicine, New York, New York, U.S.A
| | - C Douglas Phillips
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, New York, U.S.A
| | - Adetokunbo Obayemi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Victoria X Yu
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Victoria Banuchi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
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Jiang C, Liu J, Zhang J, Cui Y, Yang J, Hao F, Fan Y, Wei J. Endovascular therapy for acute basilar artery occlusion caused by vertebral artery dissection: Case report. Medicine (Baltimore) 2021; 100:e27995. [PMID: 34964795 PMCID: PMC8615330 DOI: 10.1097/md.0000000000027995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The best endovascular therapy revascularization strategies for acute ischemic stroke caused by vertebral artery dissection (VAD) are unclear. We describes a case of basilar artery (BA) occlusion caused by extracranial VAD, in which we used a stent-retriever to achieve thrombectomy in the BA through the contralateral vertebral artery (VA). PATIENT CONCERNS A 32-year-old male presented with a sudden-onset headache accompanied by articulation disorder, left-sided weakness, and tinnitus in the left ear. DIAGNOSIS Digital subtraction angiography showed the V1 to V2 segment dissection of the left VA and occlusion of the BA. INTERVENTIONS Thrombectomy was performed through the thinner right VA with three passes of the Solitaire FR device 4 × 20 mm in the BA, and angiograms showed modified treatment in cerebral ischemia 3 reperfusion of BA and left VA V4 segment still occluded. OUTCOMES The patient had a modified Rankin Scale of 2 at 90 days, and re-established blood flow of the left VA and BA. LESSONS When extracranial VAD complicated with BA occlusion, choosing the clean-road path to perform a BA thrombectomy may be a fast and effective treatment strategy.
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Affiliation(s)
- Changchun Jiang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
- Neurointerventional medical center of Inner Mongolia Medical University, Inner Mongolia, China
| | - Jiahui Liu
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
- Neurointerventional medical center of Inner Mongolia Medical University, Inner Mongolia, China
| | - Jinfeng Zhang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
- Neurointerventional medical center of Inner Mongolia Medical University, Inner Mongolia, China
| | - Yujuan Cui
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Junfeng Yang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
- Neurointerventional medical center of Inner Mongolia Medical University, Inner Mongolia, China
| | - Fei Hao
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
- Neurointerventional medical center of Inner Mongolia Medical University, Inner Mongolia, China
| | - Yu Fan
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
- Neurointerventional medical center of Inner Mongolia Medical University, Inner Mongolia, China
| | - Jianqi Wei
- Graduate School of Inner Mongolia Medical University, Inner Mongolia, China
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Bodiguel E, Naggara O, Mas JL. Dissecazione delle arterie carotidee e vertebrali extracraniche. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Stimach I, Sharma A, Southerland AM, Gornik HL. Vascular Disease Patient Information Page: Cervical artery dissection (CeAD). Vasc Med 2021; 26:674-677. [PMID: 34674593 DOI: 10.1177/1358863x211051427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ivka Stimach
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Aditya Sharma
- Heart and Vascular Center, University of Virginia, Charlottesville, VA, USA
| | | | - Heather L Gornik
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
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45
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Vertebrobasilar and internal carotid arteries dissection in 188 patients. J Clin Neurosci 2021; 93:6-16. [PMID: 34656262 DOI: 10.1016/j.jocn.2021.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/24/2021] [Accepted: 07/25/2021] [Indexed: 11/21/2022]
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Vitturi BK, Gagliardi RJ. Effectiveness of statins in patients with stroke due to cervical artery dissection: A preliminary study. Med Clin (Barc) 2021; 157:313-317. [PMID: 32826077 DOI: 10.1016/j.medcli.2020.06.056] [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: 01/31/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Statin therapy has become one of the most important advances in stroke secondary prevention. Nevertheless, statin therapy in patients who present an ischemic stroke following cervical artery dissection (CAD) has not yet been supported by clinical evidence. This study aimed to investigate the effect of statins on neurological outcomes after a stroke due to CAD. METHODS We conducted a prospective cohort study including consecutive patients diagnosed with a stroke due to CAD. Subjects were classified into non-statin, simvastatin 20mg, simvastatin 40mg, and high-potency statin groups. After 2 years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. RESULTS Among the 54 patients included in our cohort, there were 16 (29.6%) patients without statins, 22 (40.7%) with simvastatin 20mg, 12 (22.2%) with simvastatin 40mg and 4 (7.5%) with high-potency statins. Using simvastatin 40mg was associated with a significantly lower incidence of stroke recurrence. Patients with simvastatin 40mg and high-potency statins presented the best functional recovery throughout the follow-up (p<.01). DISCUSSION The use of statins in patients with CAD-related stroke may improve functional outcomes in specific cases. Statins do not prevent stroke recurrence and major cardiovascular events in this type of stroke.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, 01221-020 São Paulo, Brazil.
| | - Rubens José Gagliardi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, 01221-020 São Paulo, Brazil
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Lindsay ME, Dudzinski DM, Yoon BC, Jaff MR, Thakuria JV. Case 30-2021: A 47-Year-Old Man with Recurrent Unilateral Head and Neck Pain. N Engl J Med 2021; 385:1317-1325. [PMID: 34587390 DOI: 10.1056/nejmcpc2107347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mark E Lindsay
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
| | - David M Dudzinski
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
| | - Byung C Yoon
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
| | - Michael R Jaff
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
| | - Joseph V Thakuria
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
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Cochran T, White K, Love T, Goodrich N. Visual Diagnosis: Abnormal Behavior in a 2-month-old Boy. Pediatr Rev 2021; 42:e37-e40. [PMID: 34470876 DOI: 10.1542/pir.2020-001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Nathaniel Goodrich
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE
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Prasad N, Mitra A, Shlobin NA, Azad HA, Cloney MB, Hopkins BS, Jahromi BS, Potts MB, Dahdaleh NS. Traumatic and Spontaneous Vertebral Artery Dissections: An Analysis of Tertiary-Center 310 Patient Cohort. Oper Neurosurg (Hagerstown) 2021; 21:343-350. [PMID: 34392360 DOI: 10.1093/ons/opab277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 06/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vertebral artery dissections (VADs) are rare yet potentially devastating events. While the etiology of these events is either traumatic or spontaneous, there is a paucity of quantitative literature comparing the two. OBJECTIVE To identify differences in predisposing factors, event characteristics, and clinical outcomes between traumatic VADs (tVADs) and spontaneous VADs (sVADs). METHODS We retrospectively identified patients with VADs presenting to our institution at VAD onset with at least a 3-mo follow-up. Demographics, event characteristics, treatment details, and neurological outcomes as modified Rankin scale (mRS) scores were collected. RESULTS Of the 310 patients sustaining 366 VADs total, 187 (60.3%) patients experienced a total of 221 (60.4%) sVADs and 123 (39.7%) patients experienced a total of 145 (39.6%) tVADs. sVADs were more likely to occur in the intracranial course of the artery (P = .042) and have a lower mRS at discharge, 3-month, and last clinical follow-up (P = 003, .002, and .001, respectively). tVADs were more likely associated with concomitant fractures (P < .001). CONCLUSION Despite similar patient populations, tVADs are associated with higher mRS scores at all time points. Although further study is needed, this may suggest other concomitant trauma rather than the VAD itself is contributing to worse neurological status in patients with tVADs.
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Affiliation(s)
- Nikil Prasad
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Akash Mitra
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Hooman A Azad
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael B Cloney
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Benjamin S Hopkins
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Babak S Jahromi
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew B Potts
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Gallaer A, Archambault S, Patel SD, Mui G. Vertebral Artery Dissection in a Woman Due to Golf: An Under Recognized Etiology. Neurologist 2021; 26:132-136. [PMID: 34190206 DOI: 10.1097/nrl.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Traditionally, spontaneous cervical artery dissections have been associated with violent, sudden neck movements. These events are a significant cause of stroke related morbidity, particularly in young people. Only a handful of cases of golf-induced vertebral artery dissection (VAD) have been described, and the discussion has primarily focused on middle-aged men. Despite the discussion focused on this demographic, women are participating in golf at higher rates than ever before, and have a higher risk for developing VAD. CASE REPORT A 41-year-old woman presented to our hospital with sharp neck pain, dizziness, and ptosis after swinging a driver during a morning round of golf. Imaging demonstrated a right V3/V4 VAD and subsequent ischemic infarction. After administration of tissue plasminogen activator she had abrupt change in mental status with seizure-like activity. She underwent angiogram and mechanical thrombectomy, and was started in heparin 24 hours post-tissue plasminogen activator. This was subsequently changed to low-dose aspirin following thalamic petechial hemorrhage. She was discharged from the hospital after a few days with only minor deficits. We will discuss mechanism, treatment, and outcomes of VAD in context of this case. CONCLUSION This patient is the first woman in the literature to suffer from VAD as a result of playing golf. The twisting motion of the head and neck in a golf swing may be a risk factor for dissection and subsequent development of stroke. As a result of increased female participation in golf, we expect to see increased incidence of women presenting with "golfer's stroke" in coming years.
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