Cervical manipulation and stroke.

Easton, J D; Sherman, David G.

doi:10.1161/01.str.8.5.594

Cited by 73 publications

(16 citation statements)

References 15 publications

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“…15 " 23 Among these 15 patients, 10 vertebral dissections followed chiropractic manipulation and one followed neck manipulation by a therapist; 22 other incitants included automobile accidents (2), a direct blow to the neck by a log (1), and turning abruptly while driving a car (1). In 14 patients, the vascular lesion was located in the distal extracranial third segment of the vertebral artery as it occurred behind the atlas.…”

Section: Ap View Of the Left Subclavian Artery (Digital Subtraction Amentioning

confidence: 99%

Spontaneous dissection of the extracranial vertebral arteries.

Caplan¹,

Zarins²,

Hemmati³

1985

Stroke

195

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SUMMARY Though the syndrome of carotid artery dissection is well known, "spontaneous" vertebral artery dissection is rarely recognized. We now report clinical and radiologic findings in five patients with presumed vertebral dissection, one pathologically confirmed.Mean age was 35.2 years (range 27-41). Two were men; three women. None had hypertension, vascular disease, or trauma. Headache and neck or occipital pain was prominent in all, often preceding other symptoms. Four of five patients had unilateral partial alteral medullary syndromes, in one accompanied by medial medullary signs. One patient had a cerebellar infarct. Angiography in four patients showed severe irregular stenosis of the distal extracranial vertebral artery (three bilaterally and subsequently has been widely reported.3 " 5 Migraine 6 ' 7 and fibromuscular dysplasia 8 have been associated with arterial dissection. Intramural clot separates the media often compromising the lumen; clot can dissect into the lumen through the torn intima. Because of intimal and endothelial disruption platelet nidi can form in the lumen and reduced flow potentiates the development of intraluminal clot. Distal ischemia is caused by emoblization of luminal clot or reduced distal flow. Dissections and intimal tears are usually traumatic and are termed "spontaneous" when no definite trauma is recalled by the patient. Though "spontaneous" dissection of the vertebral artery has been reported, 19 " 14 the clinical and radiologic features are less well known than the findings in carotid dissection. We now report clinical and radiologic findings in 4 patients with presumed vertebral artery dissection and radiographic and pathologic findings in 1 patient with surgically proven vertebral dissection. The clinical and radiologic signs of spontaneous vertebral dissection closely resemble those described in vertebral artery trauma and chiropractic manipulation. She recalled no unusual recent neck motion or trauma. Two hours after awakening, she suddenly noted tingling at the corner of her left mouth and tongue, dizziness, vomiting, and a sensation that her body was being pulled to the left. Later her right hand felt cold. On examination, blood pressure and general examination were normal. Neurological abnormalities included: coarse horizontal nystagmus to the left, left facial hypalgesia, diminished left corneal response, and left limb dysmetria. She veered to the left when she walked. CT was normal. Bilateral vertebral angiography showed moderately severe narrowing and irregular stenosis of the third segment of the right vertebral artery and severe stenosis of a short segment of the third portion of the left vertebral artery ( fig. la, b). Warfarin anticoagulation was begun. Neurologic examination returned to normal and she had no symptoms. A left vertebral angiogram 5 months after onset was normal with no residual stenosis ( fig. lc). Warfarin was stopped. Two years after the original episode, the patient had no neurologic signs or symptoms. Patient 2fJ.R., a 39 year old man ha...

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Section: Ap View Of the Left Subclavian Artery (Digital Subtraction Amentioning

confidence: 99%

Spontaneous dissection of the extracranial vertebral arteries.

Caplan¹,

Zarins²,

Hemmati³

1985

Stroke

195

View full text Add to dashboard Cite

show abstract

“…12 In these cases, the cerebellar infarct, which may also be accompanied by lateral medullary infarction, is usually due to traumatic dissection of the vertebral artery secondary to forceful abrupt cervical hyperextension, a common chiropractic maneuver. 15 In reference to surgical treatment, I agree with Chen et al that the operation of choice is a suboccipital decompression carried through the foramen magnum to relieve tonsillar herniation and with removal by suction of the grossly infarcted cerebellar tissue that usually exudes "like toothpaste" upon opening of the dura. 4 -9 I also agree that ventricular drainage should not be used alone without prompt suboccipital decompression because of inadequate relief of the direct compression of the stem and the risk of upward herniation with ventriculostomy.…”

mentioning

confidence: 74%

Surgical treatment of cerebellar infarction.

Heros¹

1992

Stroke

110

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“…The segment of vertebral artery between C-1 and C-2 can be narrowed or occluded in the process 2) . Atlantoaxial instability, ossification or hypertrophy of the atlantooccipital membrane, tightness of the paravertebral musculature, or severe changes of spondylosis may also contribute to vertebral artery compression 3,5,6,8,13,14) . The second most site of VA compromise is its entrance into the C6 transverse foramen 8) .…”

Section: Discussionmentioning

confidence: 99%

“…This rare and unique symptomatic vertebrobasilar insufficiency or infaction is named "bow hunter's stroke" after the first description by Sorensen 15) . Various pathologic conditions have been reported as causes of bow hunter's stroke 3,[5][6][7]11,14) . We report a 71-year-old woman with rotatory occlusion of VA from rare massive facet hypertrophy at the C1-2 level treated by C1-2 posterior fixation and fusion.…”

Section: Introductionmentioning

confidence: 99%

Bow Hunter's Stroke Caused by a Severe Facet Hypertrophy of C1-2

Chough

Cheng

Welch

et al. 2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 47 : [134][135][136] 2010 Bow hunter's stroke is a rare symptomatic vertebrobasilar insufficiency in which vertebral artery (VA) is mechanically occluded during head rotation. Various pathologic conditions have been reported as causes of bow hunter's stroke. However, bow hunter's stroke caused by facet hypertrophy of C1-2 has not been reported. A 71-year-old woman presented with symptoms of vertebrobasilar insufficiency. Spine computed tomography showed massive facet hypertrophy on the left side of C1-2 level. A VA angiogram with her head rotated to the right revealed significant stenosis of left VA. C1-2 posterior fixation and fusion was performed to prevent serious neurologic deficit from vertebrobasilar stroke.

show abstract

Cervical manipulation and stroke.

Cited by 73 publications

References 15 publications

Spontaneous dissection of the extracranial vertebral arteries.

Spontaneous dissection of the extracranial vertebral arteries.

Surgical treatment of cerebellar infarction.

Bow Hunter's Stroke Caused by a Severe Facet Hypertrophy of C1-2

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