Mild Mechanical Traumas Are Possible Risk Factors for Cervical Artery Dissection

Abstract

Background and Purpose: Cervical artery dissection (CAD) is a common cause of ischemic stroke in younger aged subjects. Retrospective studies suggest cervical manipulative therapy (CMT) and preceding infections as extrinsic risk factors for CAD. In a case-control study, we assessed a questionnaire with 7 mild mechanical traumas as potential trigger factors for CAD, including CMT and recent infections. Patients and Methods: Forty-seven consecutive patients with CAD were compared with 47 consecutive patients of similar age with ischemic stroke due to etiologies other than CAD. Patients underwent a standardized face-to-face interview. We assessed head or neck pain and recent infection <7 days before symptom onset, as well as the following mechanical trigger factors <24 h and <7 days prior to symptom onset: (1) heavy lifting, (2) sexual intercourse, (3) mild direct or (4) indirect neck trauma, (5) jerky head movements, (6) sports activity, and (7) CMT. Results:We found no association between any single one of the above risk factors and CAD. CMT (CAD, n = 10; non-CAD, n = 5) and recent infections (CAD, n = 18; non-CAD, n = 10) were more frequent in the CAD group but failed to reach significance. However, the cumulative analysis of all mechanical trigger factors revealed a significant association of mechanical risk factors as a whole in CAD <24 h prior to symptom onset (p = 0.01). Conclusion: Mild mechanical stress, including CMT, plays a role as possible trigger factor in the pathogenesis of CAD. CMT and recent infections alone failed to reach significance during the present investigation, presumably due to the relatively small sample size of the study cohort.

Manual therapy and cervical artery dysfunction: Identification of potential risk factors in clinical encounters

“…This finding has also been supported in more recent reviews by Dittrich et al 79 and Thomas et al 43 In contrast, Metso et al 17 …”

“…79 A case study by Gilberti et al 64 reported the onset of an ICAD following "head-banging" at a rock concert, reinforcing the need to establish the mode of onset of the patient's current complaint as part of the clinical history. However, these authors did not provide any information as to whether there was a pre-existing vascular pathology or risk factors that may have contributed to the development of the ICAD.…”

The role of the carotid sinus in the reduction of arterial wall stresses due to head movements—potential implications for cervical artery dissection

“…Most current hypotheses for sICAD acknowledge the probability of some underlying predisposing factor combined with an initiating event that is most likely a trivial trauma of some degree (Dittrich et al, 2007;Haneline and Lewkovich, 2005). Previously, however, the association of an initiating trivial trauma has been based on phenomenological information such as association of the onset of symptoms with regular events including sporting activities, sneezing, dental treatment and reversing a car (Kumar et al, 1998;Schievink, 2001;Siwiec and Solomon, 2007;Taylor and Kerry, 2005).…”

Differences and Similarities Between Spontaneous Dissections of the Internal Carotid Artery and the Vertebral Artery

“…Spontaneous dissection was defined as occurring spontaneously, after physical exertion, or a so-called minor trauma. 6 Patients with previous sCAD were not included.…”