Chiro.org - Chiropractic Resource Organization.     Support Chiropractic Research!

Vertebral Artery

Home/Vertebral Artery

Spontaneous Cervical Artery Dissection

By |August 2, 2018|Stroke, Vertebral Artery|

Spontaneous Cervical Artery Dissection:
A Fluoroquinolone Induced Connective Tissue Disorder?

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2018 (Jul 9); 26: 22

James S. Demetrious, DC, FACO

Wilmington, NC, USA.


BACKGROUND:   Spontaneous cervical artery dissections more often manifest in young people and have been associated with catastrophic consequences. Some indeterminate risk factors have been identified, making the diagnosis of developing dissections quite difficult. Fluoroquinolone antibiotics have been recognized for their degradative effects on connective tissue. Recent studies have implicated fluoroquinolones in the genesis of aortic artery aneurysms. It is the purpose of this paper to provide reasoning for a testable hypothesis of whether fluoroquinolones constitute a risk factor associated with cervical artery dissections.

METHODS:   A PubMed search was conducted to investigate whether cervical artery dissection has been associated with fluoroquinolone use. An assessment of risk factors was made of hereditary connective tissue disorders, infection, and seasonal predisposition related to cervical artery dissection. These factors were considered in conjunction with reports of connective tissue toxicity associated with fluoroquinolone medications.

RESULTS:   It appears that no reported cases of cervical artery dissection have previously been correlated with fluoroquinolone use. Heritable connective tissue disorders, infection, seasonal predisposition and condition latencies are associated with fluoroquinolone medications. Several recent articles have implicated fluoroquinolones with aortic dissections and aneurysm.

There are more articles like this @ our:

Stroke and Chiropractic Page

(more…)

Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury

By |March 16, 2015|Vertebral Artery|

Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury

The Chiro.Org Blog


J Manipulative Physiol Ther 1995 (May);   18 (4):   203–210

Terrett AG

School of Chiropractic and Osteopathy,
Faculty of Biomedical and Health Sciences,
RMIT University,
Bundoora, Australia


This Full Text article is reprinted with the permission of National College of Chiropractic and JMPT.   Our special thanks to the Editor, Dr. Dana Lawrence, D.C. for permission to reproduce this article exclusively at Chiro.Org


You may also want to review Wenban’s more recent article:

Inappropriate Use of the Title Chiropractor and Term Chiropractic Manipulation in the Peer-reviewed Biomedical Literature


OBJECTIVE:  This study was conducted to determine how the words chiropractic and chiropractor have been used in publications in relation to the reporting of complications from cervical spinal manipulation therapy (SMT).

STUDY DESIGN:  The study method was to collect recent publications relating to spinal manipulation iatrogenesis which mentioned the words chiropractic and/or chiropractor and then determine the actual professional training of the practitioner involved.

METHOD:  The training of the practitioner in each report was determined by one of three means: surveying previous publications, surveying subsequent publications and/or by writing to the author(s) of ten recent publications which had used the words chiropractic and/or chiropractor.

RESULTS:  This study reveals that the words chiropractic and chiropractor commonly appear in the literature to describe SMT, or practitioner of SMT, in association with iatrogenic complications, regardless of the presence or absence of professional training of the practitioner involved.

CONCLUSION:  The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a non–chiropractor. The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader’s opinion of chiropractic and chiropractors.

There are more articles like this @ our:

Stroke and Chiropractic Page


From the Full-Text Article:

INTRODUCTION

Among the health professions, chiropractic has an impressive safety record for its 99-yr existence [1, 2]. Chiropractors in Australia are aware that complications can occur after spinal manipulation therapy (SMT), and, as responsible professionals, they have investigated and instituted procedures to minimize their occurrence [2-19]. In fact “the incidence and mechanisms are better reported in the chiropractic literature than elsewhere” [20].


METHODS

(more…)

The Etiology of Cervical Artery Dissection

By |February 26, 2015|Diagnosis, Vertebral Artery|

The Etiology of Cervical Artery Dissection

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2007 (Summer);   6 (3):   110-120 ~ FULL TEXT

Michael T. Haneline [a], and Anthony L. Rosner [b]

a   Professor,
Palmer College of Chiropractic West,
Department of Research, San Jose, CA 95134
michael.haneline@palmer.edu

b   Professor,
Parker College of Chiropratic,
Brookline, MA 02446


The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.


From the FULL TEXT Article:

Introduction

The etiology of cervical artery dissection (CAD) is, for the most part, unclear; and what has been proposed as an explanation for its pathogenesis is largely hypothetical. [1] Furthermore, when dealing with a particular case of CAD, the pathogenesis is especially speculative. [2] Nevertheless, a number of risk factors have been reported to be associated with the condition, including connective tissue abnormalities, hypertension, recent infection, migraine headache, the use of oral contraceptives, and others. Of special interest to chiropractors is the role cervical spine manipulation (CSM) plays, if any, in the pathogenesis of CAD. Indeed, patients do experience CAD on rare occasions after CSM, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition important for chiropractors.

Anatomy of the cervical arteries

There are more articles like this @ our:

Stroke and Chiropractic Page

(more…)

Recognition of Spontaneous Vertebral Artery Dissection

By |February 25, 2015|Diagnosis, Vertebral Artery|

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   90-95 ~ FULL TEXT

Ross Mattox, DC, [a], Linda W. Smith, DC, [b] and
Norman W. Kettner, DC, DACBR, FICC [c]

a   Diagnostic Imaging Resident,
Department of Radiology,
Logan University, Chesterfield, MO
ude.nagol@xottam.ssor

b   Chiropractic Physician,
Private Practice, St. Louis, MO

c   Chair, Department of Radiology,
Logan University, Chesterfield, MO


OBJECTIVE:   The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache.

CLINICAL FEATURES:   A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated.

INTERVENTION AND OUTCOME:   Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital.

There are more articles like this @ our:

Stroke and Chiropractic Page

(more…)

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

By |February 23, 2015|Diagnosis, Vertebral Artery|

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   128–133 ~ FULL TEXT

Bart N. Green, DC, MSEd,a,b, LCDR Kristin M. Browske, MD,
and CAPT Michael D. Rosenthal, PT, DSc, ATC

a   Chiropractor,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego, CA

b   Associate Editor,
Publications Department,
National University of Health Sciences,
Lombard, IL

Corresponding author at:
Marine Corps Air Station Miramar,
Branch Health Clinic,
PO Box 452002,
San Diego, CA 92145-2002. Tel.: + 1 858 577 9948
lim.yvan.dem@neerg.traB


Objective   The purpose of this paper is to present a case of a patient with neck pain, tinnitus, and headache in the setting of bilateral elongated styloid processes (ESP) and calcified stylohyoid ligaments (CSL), how knowledge of this anatomical variation and symptomatic presentation affected the rehabilitation management plan for this patient, and to discuss the potential relevance of ESPs and CSLs to carotid artery dissection.

Clinical features   A 29-year-old male military helicopter mechanic presented for chiropractic care for chronic pain in the right side of his neck and upper back, tinnitus, and dizziness with a past history of right side parietal headaches and tonsillitis. Conventional radiographs showed C6 and C7 spinous process fractures, degenerative disc disease at C6/7, and an elongated right styloid process with associated calcification of the left stylohyoid ligament. Volumetric computerized tomography demonstrated calcification of the stylohyoid ligaments bilaterally.

Intervention and outcome   Given the proximity of the calcified stylohyoid apparatus to the carotid arteries, spinal manipulation techniques were modified to minimize rotation of the neck. Rehabilitation also included soft tissue mobilization and stretching, corrective postural exercises, and acupuncture. An otolaryngologist felt that the symptoms were not consistent with Eagle syndrome and the tinnitus was associated with symmetric high frequency hearing loss, likely due to occupational noise exposure. Initially, the patient’s symptoms improved but plateaued by the fifth visit.

There are more articles like this @ our:

Case Reports Section and our:

Stroke and Chiropractic Page

(more…)

Vertebral Artery Dissection in a Patient Practicing Self-manipulation of the Neck

By |October 17, 2014|Vertebral Artery|

Vertebral Artery Dissection in a Patient Practicing Self-manipulation of the Neck

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2011 (Dec);   10 (4):   283–287

John S. Mosby, DC, MD, Stephen M. Duray, PhD

Division of Clinics,
Palmer College of Chiropractic,
Davenport, IA 52803, USA


OBJECTIVE:   The purpose of this case report is to describe a patient who regularly practiced self-manipulation of her neck who presented with shoulder and neck pain and was undergoing a vertebral artery dissection.

CLINICAL FEATURES:   A 42-year-old female patient sought care for left shoulder pain with a secondary complaint of left lower neck pain. Twelve days prior, she had had “the worst headache of her life,” which began in her left lower cervical spine and extended to her left temporal region. The pain was sudden and severe, was described as sharp and burning, and lasted 3 hours. She reported nausea, vomiting, and blurred vision.

INTERVENTION AND OUTCOME:   Initial history and examination suggested that the patient’s head and neck pain was not musculoskeletal in origin, but vascular. She repeatedly requested that an adjustment be performed, but instead was referred to the local emergency department for further evaluation. Magnetic resonance angiogram revealed a dissection of the left vertebral artery from C6 to the C2-C3 interspace and a 3-mm dissecting pseudoaneurysm at the C3 level. She underwent stent-assisted percutaneous transluminal angioplasty combined with antiplatelet therapy (clopidogrel) and experienced a good outcome.

There are more articles like this @ our:

Stroke and Chiropractic Page

(more…)