Identification of Cervical Artery Dissections: Imaging Strategies and Literature Review

Malik, Adrienne; Thom, Stephanie; Bernath, Kristi; Pearce, Elspeth; Donnawell, Kayla; DO, Brittany Hudson-Walsh

doi:10.1007/s40138-022-00247-y

Cited by 1 publication

(3 citation statements)

References 38 publications

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“…VAD is a difficult diagnosis to make and requires advanced vascular imaging considering there are no specific or reliable bedside tests for this condition [2,[51][52][53]. Neck pain and headache are highly prevalent in general and in the VAD population, yet nonspecific for VAD in isolation [2,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the incidence of VAD is low [ 54 ], therefore, it is impractical and potentially harmful to obtain advanced vascular imaging for all patients presenting with only neck pain and headaches. Vascular imaging can be costly, have limited availability, may unnecessarily expose patients to contrast agents with risk of allergy [ 51 ], could reveal incidental findings that lead to patient anxiety without providing clinical benefit, and may delay necessary care if patients are required to undergo testing before treatment for their pain. Accordingly, VAD is frequently missed in a range of healthcare settings [ 2 , 4 , 52 ].…”

Section: Reviewmentioning

confidence: 99%

“…Additionally, case reports rely on patient-reported symptoms, potentially leading to inaccuracies in the medical history and risk factors. Our secondary outcomes based on imaging findings should be interpreted with caution in older cases given radiological advancements in recent years [ 51 ]. We were unable to estimate the incidence of VAD presenting to chiropractors based on case reports.…”

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Symptoms of Patients With Vertebral Artery Dissection Presenting to Chiropractors: A Systematic Review and Meta-Analysis

Trager,

Troutner,

Pikus

et al. 2023

Cureus

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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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