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

Stroke

Home/Stroke

A Risk-benefit Assessment Strategy to Exclude Cervical Artery Dissection in Spinal Manual-therapy

By |May 25, 2019|Stroke|

A Risk-benefit Assessment Strategy to Exclude Cervical Artery Dissection in Spinal Manual-therapy: A Comprehensive Review

The Chiro.Org Blog


SOURCE:   Annals of Medicine 2019 (Mar 19): 1–10 [Epub]

Aleksander Chaibi & Michael Bjørn Russell

Head and Neck Research Group,
Research Centre, Akershus University Hospital,
Oslo, Norway.


Cervical artery dissection refers to a tear in the internal carotid or the vertebral artery that results in an intramural haematoma and/or an aneurysmal dilatation. Although cervical artery dissection is thought to occur spontaneously, physical trauma to the neck, especially hyperextension and rotation, has been reported as a trigger. Headache and/or neck pain is the most common initial symptom of cervical artery dissection. Other symptoms include Horner’s syndrome and lower cranial nerve palsy. Both headache and/or neck pain are common symptoms and leading causes of disability, while cervical artery dissection is rare. Patients often consult their general practitioner for headache and/or neck pain, and because manual-therapy interventions can alleviate headache and/or neck pain, many patients seek manual therapists, such as chiropractors and physiotherapists. Cervical mobilization and manipulation are two interventions that manual therapists use. Both interventions have been suspected of being able to trigger cervical artery dissection as an adverse event. The aim of this review is to provide an updated step-by-step risk-benefit assessment strategy regarding manual therapy and to provide tools for clinicians to exclude cervical artery dissection.

Key messages

  • Cervical mobilization and/or manipulation have been suspected to be able to trigger cervical artery dissection (CAD). However, these assumptions are based on case studies which are unable to established direct causality.

    There are more articles like this @ our:

    STROKE AND CHIROPRACTIC Page

    (more…)

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…)

Vertebral Artery Dissection as a Cause of
Cervical Radiculopathy

By |April 19, 2016|Stroke|

Vertebral Artery Dissection as a Cause
of Cervical Radiculopathy

The Chiro.Org Blog


SOURCE:   Asian Spine J. 2013 (Dec); 7 (4): 335–338

Benjamin Isaac Silbert, Mark Khangure, and
Peter Linton Silbert

Department of Neurology,
Royal Perth Hospital,
Perth, Australia.


The acute onset of neck pain and arm weakness is most commonly due to cervical radiculopathy or inflammatory brachial plexopathy. Rarely, extracranial vertebral artery dissection may cause radiculopathy in the absence of brainstem ischemia. We describe a case of vertebral artery dissection presenting as cervical radiculopathy in a previously healthy 43-year-old woman who presented with proximal left arm weakness and neck pain aggravated by movement. Cervical magnetic resonance imaging (MRI) and angiography revealed dissection of the left vertebral artery with an intramural hematoma compressing the left C5 and C6 nerve roots. Antiplatelet treatment was commenced, and full power returned after 2 months. Recognition of vertebral artery dissection on cervical MRI as a possible cause of cervical radiculopathy is important to avoid interventions within the intervertebral foramen such as surgery or nerve root sleeve injection. Treatment with antithrombotic agents is important to prevent secondary ischemic events.

KEYWORDS:   Cervical spine; Neck pain; Radiculopathy; Vertebral artery dissection


From the FULL TEXT Article:

Introduction

There are more articles like this @ our:

Stroke and Chiropractic Page

(more…)

Chiropractic Response to a Spontaneous Vertebral Artery Dissection

By |April 18, 2016|Stroke|

Chiropractic Response to a Spontaneous Vertebral Artery Dissection

The Chiro.Org Blog


SOURCE:   J Chiro Med 2015 (Sep); 14 (3): 183–190 ~ FULL TEXT

Gary Tarola, DC, and Reed B. Phillips, DC

Private Practice,
Lehigh Valley Medical Network,
Allentown, PA.


OBJECTIVE:   The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes.

CLINICAL FEATURES:   A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient’s pain in the most severe category.

INTERVENTION AND OUTCOME:   The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately.

There are more articles like this @ our:

Stroke and Chiropractic Page

(more…)

Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection

By |March 26, 2016|Stroke|

Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection:
No Evidence for Causation

The Chiro.Org Blog


SOURCE:   Cureus 2016 (Feb 16);   8 (2):   e498

Ephraim W. Church, MD,   Emily P. Sieg, MD,
Omar Zalatimo, MD,   Namath S. Hussain, MD,
Michael Glantz, MD,   Robert E. Harbaugh, MD

Department of Neurosurgery,
Penn State Hershey Medical Center


BACKGROUND:   Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD.

METHODS:   Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria.

RESULTS:   Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was “very low.”

There are more articles like this @ our:

Stroke and Chiropractic Page

(more…)

Recognition of Perinatal Stroke in a Chiropractic Practice

By |February 2, 2016|Pediatrics, Stroke|

Recognition of Perinatal Stroke in a Chiropractic Practice: Case Report and Clinical Challenges Related to a Late Diagnosis

The Chiro.Org Blog


J Clin Chiro Peds 2012 (Jun); 13 (1): 958–967 ~ FULL TEXT

Lise Hestbaek, PhD, Annette Jørgensen, DC, and
Jan Hartvigsen, PhD

Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark


Introduction:   In recent years, improvements in medical techniques and technology have enabled primary health care practitioners to diagnose perinatal strokes in infants far earlier than ever before. This new technology can also support chiropractors, especially those working with pediatric patients, in order to validate their diagnosis when they recognize these initial symptoms.

Objective:   The aim of this paper is to raise awareness and assist doctors of chiropractic in recognizing the physical and behavioral signs of perinatal stroke as they present in a chiropractic office for assessment and treatment. The paper will relate the case of a
7-month-old infant who, after visiting a chiropractic office with apparent hemiparesis and delayed developmental milestones, was post-medically diagnosed as having suffered a presumed perinatal stroke.

Discussion:   Early recognition of perinatal stroke is vital since late diagnosis can lead to a lifetime of debilitating neurological conditions as well as potential increased direct and indirect costs to society. For those who receive a late diagnosis, a chiropractor, as a member of a multidisciplinary team, can play a major role in rehabilitation by supporting the function of the nervous system,
reducing muscle and joint rigidity and optimizing neuronal plasticity.

There are more articles like this @ our:

Stroke and Chiropractic Page

(more…)