The etiology of cervical artery dissection

Haneline, Michael T.; Rosner, Anthony L.

doi:10.1016/j.jcme.2007.04.007

Cited by 38 publications

(26 citation statements)

References 73 publications

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“…8,9 Those who were diagnosed with VAD after SMT were likely already experiencing a VAD before presentation, or had a predisposition to dissection. 24,25 Cassidy et al concluded that there was a similar association in patients who sought clinical care for symptoms of VAD (neck pain and headache) and proceeded to have a stroke, regardless of whether management was by chiropractic or medical care. 4 Digital subtraction angiography has been the gold standard in imaging of arterial dissection.…”

Section: Discussionmentioning

confidence: 99%

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

Mattox

Smith²,

Kettner

2014

Journal of Chiropractic Medicine

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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 V 2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital. Conclusion: This case highlights the potential for patients with vertebral artery dissection to present with nonspecific musculoskeletal complaints. Neurological symptoms may not manifest initially, but their sudden onset indicates the possibility of an ischemic cerebrovascular event. We suggest that early recognition and emergent referral for this patient avoided potential exacerbation of an evolving pre-existing condition and resulted in timely anticoagulation treatment.

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Section: Discussionmentioning

confidence: 99%

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

Mattox

Smith²,

Kettner

2014

Journal of Chiropractic Medicine

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“…Internal carotid artery dissection can be a result of mechanical forces such as trauma or stretching7 8 as well as underlying connective tissue disorders such as Ehlers–Danlos syndrome IV 4 9. Other risk factors include hypertension, hyperlipidaemia, diabetes mellitus, smoking and the combined contraceptive pill 4…”

Section: Discussionmentioning

confidence: 99%

Fell off of a horse - journey from Emergency Department to Stroke clinic

Traer

Loganathan²,

Sinha³

et al. 2010

Case Reports

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“…Dissection of the carotid artery can occur spontaneously or on the basis of arterial disease such as connective tissue disorders, vasculitis or fibromuscular dysplasia and exceptionally atherosclerotic lesions. Particularly, blunt neck trauma or chiropractic manipulations can tear the intima of the vessel creating a wall hematoma and even a false lumen [43,44]. On CTA and DSA carotid dissections are characterized by gradual narrowing of the vessel lumen in a 'duck bill' or 'flame' configuration (Figures 6-8).…”

Section: • • the Atherosclerotic Carotid Lesionmentioning

confidence: 99%

Carotid stent-assisted Thrombectomy in Acute Ischemic Stroke

Steglich-Arnholm

Krieger

2015

Future Cardiol.

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Acute carotid occlusion or near-occlusion with concomitant intracranial embolism cause severe acute ischemic strokes in patients. These concomitant occlusions have suggested poor response to intravenous thrombolysis and complicate endovascular treatment. Nevertheless, endovascular stent-assisted thrombectomy may improve outcome in patients but the treatment is not without concerns. Required antiplatelet therapy to prevent stent thrombosis may increase the rate of intracranial hemorrhage, especially after recent thrombolysis. Furthermore, technical difficulties in access of the intracranial vasculature may cause adverse events, even in the hands of experienced interventionalists. These concerns currently defy the treatment in being recommended for general use and only on a compassionate basis. However, recent patient series have suggested reasonable safety and efficacy for carotid stent-assisted thrombectomy. KEYWORDS• antiplatelet hemorrhage • atherosclerosis • carotid stent-assisted thrombectomy • stroke dissection Acute ischemic stroke (AIS) is the leading cause of acquired long-term disability and the fourth most cause of death [1]. Severity of AIS varies from minor focal neurological deficits to life-threatening hemispheric syndromes. Severe AIS caused by an occlusion of a large intracranial artery comprise 15-20% of all AIS [2,3]. In approximately 20-30% of patients with a large intracranial occlusion a concomitant occlusion or near-occlusion is found in the ipsilateral extracranial internal carotid artery (ICA) [4,5]. This extracranial occlusion is thought to be the origin of the intracranial occlusion by artery to artery embolism. A carotid occlusion or near-occlusion can be caused by an arterial dissection or atherosclerotic plaque and discrimination may have impact on peri-and post-procedural management. Although ICA lesions can cause cerebral ischemia in different ways, such as by compromised hemodynamic or microemboli with impaired washout, this review will only focus on ICA lesions with concomitant intracranial emboli in the acute stroke setting.Due to the high oxygen requirement of brain tissue, expeditious management is crucial for reversal of ischemia and successful salvage of the ischemic tissue at risk [6]. Intravenous thrombolysis (IVT) with administration of intravenous recombinant plasminogen activator (iv-tPA) is currently the recommended treatment for AIS within 4.5 h of symptom onset [7,8]. However, in patients suffering moderate-to-severe AIS from acute large vessel occlusions, IVT is often ineffective [9,10]. Studies suggest clinical improvement in only 20-30% of patients with this configuration of large vessel occlusions with IVT alone [10][11][12][13].Carotid endarterectomy (CEA) is not the preferred option, as surgery would only address the extracranial carotid occlusion without access to the intracranial occlusion that would require intra-arterial management [14]. Furthermore, surgery is not advocated to repair carotid dissections.Endovascular therapy (EVT) with mechanical thrombectom...

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The etiology of cervical artery dissection

Cited by 38 publications

References 73 publications

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

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

Fell off of a horse - journey from Emergency Department to Stroke clinic

Carotid stent-assisted Thrombectomy in Acute Ischemic Stroke

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