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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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Morales Vidal S, Lara C, Gordin A. Sequential Bilateral Vertebral Artery Dissections with Prompt Resolution of Initial Insult. Case Rep Neurol 2020; 12:189-198. [PMID: 32647525 PMCID: PMC7325214 DOI: 10.1159/000506766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022] Open
Abstract
Vertebral arterial dissection is a known cause of stroke in young adults. There has been a multitude of cases of bilateral vertebral dissections, including progression from one vertebral artery to another. This case reports the curious sequential nature of the healing of a previously dissected vertebral artery with subsequent dissection of the collateral vertebral artery. Follow-up neuroimaging evaluation performed several months later showed healed bilateral vertebral artery. The potential trigger was neck cracking.
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Affiliation(s)
- Sarkis Morales Vidal
- Department of Neurology, Loyola University Medical Center, Maguire Center, Maywood, Illinois, USA
| | - Carlos Lara
- Department of Neurology, Loyola University Medical Center, Maguire Center, Maywood, Illinois, USA
| | - Ari Gordin
- Department of Neurology, Loyola University Medical Center, Maguire Center, Maywood, Illinois, USA
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Gomez‐Rojas O, Hafeez A, Gandhi N, Berghea R, Halalau A. Bilateral Vertebral Artery Dissection: A Case Report with Literature Review. Case Rep Med 2020; 2020:8180926. [PMID: 33101417 PMCID: PMC7568148 DOI: 10.1155/2020/8180926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/24/2020] [Accepted: 04/13/2020] [Indexed: 12/20/2022] Open
Abstract
Vertebral artery dissection (VAD) is a rare cause of ischemic stroke in young patients. The largely nonspecific symptoms and delayed presentation pose a serious diagnostic challenge. Medical management with either anticoagulation or antiplatelet therapy is recommended, but there are no reports of successful dual therapy. We report a case of spontaneous bilateral vertebral artery dissections (VADs) treated with both anticoagulation and antiplatelet therapy and a literature review on clinical presentation and the current medical and surgical management options. A 37-year-old healthy female presented to the emergency department with worsening neck pain and headache for two weeks despite over-the-counter medication, block therapy, yoga, and deep tissue neck massage. She denied any trauma but admitted to multiple roller coaster rides over the past few months. CT angiography was concerning for VADs, and MRI brain revealed multiple strokes in the left posterior inferior cerebellar artery (PICA) territory. Cerebral arteriography confirmed the diagnosis of VADs. The patient was initiated on warfarin, along with atorvastatin and aspirin. She was discharged home with no complications and followed up with neurology as an outpatient. MR angiography after three months revealed complete resolution of the dissection. The patient did not report any bleeding complications from dual therapy.
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Affiliation(s)
- Olga Gomez‐Rojas
- Office of Occupational Health, Alexander von Humboldt Peruvian German School, Lima, Peru
| | - Adam Hafeez
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Nikhil Gandhi
- Internal Medicine Department, Ascension Health, St.John Hospital, Detroit, MI, USA
| | - Ramona Berghea
- Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Alexandra Halalau
- Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Qi J, Zhang S, Zhang L, Ping R, Ping K, Ye D, Shen H, Chen Y, Li Y. Uniaxial Tensile Properties of Atherosclerotic Carotid Artery After Mobilization of Pushing on Qiao-Gong: A Safety Study Using an Animal Model of Carotid Atherosclerosis. J Manipulative Physiol Ther 2019; 41:164-173. [PMID: 29482828 DOI: 10.1016/j.jmpt.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/17/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to preliminarily explore the effects of the soft tissue mobilization of pushing on Qiao-Gong (MPQ) on biomechanical properties of the carotid artery using an animal model of carotid atherosclerosis (CAS). METHODS Fifty rabbits were randomly divided into 4 groups: animals with CAS treated with MPQ (CAS-MPQ [n = 15]); animals with CAS treated without MPQ (CAS [n = 15]); normal animals treated with MPQ (normal-MPQ [n = 10]); and a blank control group (n = 10). The MPQ procedure consisted of soft tissue mobilization of the Qiao-Gong acupoint on the front edge of the sternocleidomastoid muscle applied from top to bottom, by flat pushing with the thumb repeatedly for 20 times. Disease in the CAS models was induced by carotid artery balloon injury combined with a high-fat diet for 12 weeks. At the end of modeling, carotid color Doppler ultrasonography examination was performed to confirm which animal models were successfully induced with CAS, excluding model rabbits without typical CAS at the same time. Then, MPQ was applied on rabbits in the CAS-MPQ and the normal-MPQ groups for 3 weeks. By contrast, rabbits in the other 2 groups were fed normally without MPQ. Uniaxial failure tests were later performed on carotid arteries in all 4 groups, and at the end of the study, a 2-way factorial analysis of variance of the results was conducted. RESULTS (1) At the end of modeling, 10 rabbits in the CAS-MPQ group and 9 in the CAS group were included with typical carotid atherosclerotic characteristics. (2) Young's elastic modulus of the rabbit carotid artery increased more significantly in the CAS-MPQ group than the CAS group. (3) Compared with normal rabbit carotid arteries, atherosclerotic carotid arteries had lower levels of ultimate stress and ultimate strain but higher levels of ultimate load. CONCLUSIONS The uniaxial tensile mechanical properties of the rabbit atherosclerotic carotid artery were impaired after MPQ.
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Affiliation(s)
- Ji Qi
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Shaoqun Zhang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Lei Zhang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Ruiyue Ping
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Kaike Ping
- School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Da Ye
- University of Sydney, Sydney, Australia
| | - Honggui Shen
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yili Chen
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China.
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ARIYADA K, SHIBAHASHI K, HODA H, WATANABE S, NISHIDA M, HANAKAWA K, MURAO M. Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review. Neurol Med Chir (Tokyo) 2019; 59:154-161. [PMID: 30880295 PMCID: PMC6465530 DOI: 10.2176/nmc.cr.2018-0239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 12/28/2018] [Indexed: 11/30/2022] Open
Abstract
Multi-vessel cervical arterial injury after blunt trauma is rare, and its pathophysiology is unclear. Although blunt cerebrovascular injury is a common cause of cerebral ischemia, its management is still controversial. We describe a 23-year-old man in previously good health who developed three-vessel cervical arterial dissections due to blunt trauma. He was admitted to our emergency and critical care center after a motor vehicle crash. Computed tomography showed a thin, acute subdural hematoma in the right hemisphere and fractures of the odontoid process (Anderson type III), pelvis, and extremities. He was treated conservatively, and about 1 month later, he developed bleariness. Computed tomography angiography showed bilateral internal carotid and left vertebral artery dissection. Aspirin therapy was started immediately, and then clopidogrel was added to the regimen. Two weeks later, magnetic resonance angiography (MRA) showed improved blood flow of the vessels. Only aspirin therapy was continued. About 3 months after discharge, MRA demonstrated further improvement of the blood flow of both internal carotid arteries, but the dissection flap on the right side remained. Therefore, we extended the duration of antiplatelet therapy. On the basis of our experience with this case, we think that antithrombotic therapy is crucial for the management of multi-vessel cervical arterial injury, and agents should be used properly according to the injury grade and phase; however, further study is needed to confirm this recommendation.
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MESH Headings
- Angiography, Digital Subtraction
- Carotid Artery, Internal, Dissection/diagnosis
- Carotid Artery, Internal, Dissection/etiology
- Carotid Artery, Internal, Dissection/therapy
- Humans
- Magnetic Resonance Angiography
- Male
- Vertebral Artery Dissection/diagnosis
- Vertebral Artery Dissection/etiology
- Vertebral Artery Dissection/therapy
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/therapy
- Young Adult
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Affiliation(s)
- Kenichi ARIYADA
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Keita SHIBAHASHI
- Department of Emergency and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Hidenori HODA
- Department of Emergency and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Shinta WATANABE
- Department of Emergency and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Masahiro NISHIDA
- Department of Emergency and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kazuo HANAKAWA
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Masahiko MURAO
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Bilateral Carotid and Vertebral Artery Dissection from Blunt Trauma. Case Rep Emerg Med 2018; 2018:1919034. [PMID: 29721341 PMCID: PMC5867688 DOI: 10.1155/2018/1919034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/11/2018] [Indexed: 12/03/2022] Open
Abstract
Carotid and vertebral artery injuries are rare following blunt trauma. They can, however, lead to severe consequences with a significant associated rate of stroke and intracranial hemorrhage, particularly if the diagnosis and treatment are delayed. We report a case of a 23-year-old female who presented to the Emergency Department with bilateral carotid and vertebral artery dissection following a motor vehicle collision (MVC).
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Posadzki P, Ernst E. The safety of massage therapy: an update of a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/fct.12007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul Posadzki
- Complementary Medicine, Peninsula Medical School; University of Exeter; Veysey Building, Salmon Pool Lane; Exeter; EX2 4SG; UK
| | - Edzard Ernst
- Complementary Medicine, Peninsula Medical School; University of Exeter; Veysey Building, Salmon Pool Lane; Exeter; EX2 4SG; UK
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Ali MS, Amenta PS, Starke RM, Jabbour PM, Gonzalez LF, Tjoumakaris SI, Flanders AE, Rosenwasser RH, Dumont AS. Intracranial vertebral artery dissections: evolving perspectives. Interv Neuroradiol 2012; 18:469-83. [PMID: 23217643 DOI: 10.1177/159101991201800414] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 08/25/2012] [Indexed: 11/16/2022] Open
Abstract
Intracranial vertebral artery dissection (VAD) represents the underlying etiology in a significant percentage of posterior circulation ischemic strokes and subarachnoid hemorrhages. These lesions are particularly challenging in their diagnosis, management, and in the prediction of long-term outcome. Advances in the understanding of underlying processes leading to dissection, as well as the evolution of modern imaging techniques are discussed. The data pertaining to medical management of intracranial VADs, with emphasis on anticoagulants and antiplatelet agents, is reviewed. Surgical intervention is discussed, including, the selection of operative candidates, open and endovascular procedures, and potential complications. The evolution of endovascular technology and techniques is highlighted.
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Affiliation(s)
- M S Ali
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Keilani ZM, Berne JD, Agko M. Bilateral internal carotid and vertebral artery dissection after a horse-riding injury. J Vasc Surg 2010; 52:1052-7. [PMID: 20888534 DOI: 10.1016/j.jvs.2010.05.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 05/13/2010] [Accepted: 05/15/2010] [Indexed: 11/25/2022]
Abstract
Blunt cerebrovascular injuries, defined as blunt injuries to the internal carotid or vertebral arteries, are uncommon and usually occur in victims of high-speed deceleration motor vehicle crashes. A blunt cerebrovascular injury after an equestrian accident is an extremely unusual presentation. In recent years, advances in screening and treatment with pharmacologic anticoagulation before the onset of neurologic symptoms have improved outcomes for these patients. Endovascular stenting and embolization, although unproven, offer a new potential approach for these complex injuries. We present a unique case of four-vessel blunt cerebrovascular injuries after a horse-riding injury that required multidisciplinary management.
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Affiliation(s)
- Zeid M Keilani
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
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RuDusky B. Response to Facial Massage and Bilateral Carotid and Bilateral Vertebral Artery Dissection. Angiology 2009; 60:519. [DOI: 10.1177/0003319709333227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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