Vertebral Artery Dissection in Sport: A Systematic Review

Saw, Anna E; McIntosh, Andrew S.; Kountouris, Alex; Newman, Phil; Gaida, James Edmund

doi:10.1007/s40279-019-01066-0

Cited by 20 publications

(12 citation statements)

References 105 publications

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“…These cases with unusual neck movement underscore the importance of considering a differential diagnosis in athletes [84,99], since the failure of detection and management of vertebral artery dissection has the potential for neurologic sequelae or death, [83,86]. A recent systematic review echoes these findings [104].…”

Section: Discussionmentioning

confidence: 97%

Stroke and Athletes: A Scoping Review

Doyle‐Baker

Mitchell

Hayden

2021

IJERPH

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Stroke (i.e., cerebrovascular accident) affects one in 10,000 people between the ages of 14 and 45; however, very little is known about the frequency and type of stroke that occurs in athletes. The risk of injury to the neurovascular structures may depend on the type of sport involvement, although, sport-specific incidence rates are not known. Therefore, the goal of our scoping review was to provide some guidance to better inform the development of a context-fit stroke model by summarizing studies on a broad research topic related to stroke or cerebrovascular accident in sport based on a strict athlete definition. We used the guidance of Arksey and O’Malley’s five-stage-process for a scoping review. Databases included MEDLINE(R) Epub Ahead of Print, In-Process & Other Non- Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), and Embase (OVID databases); CINAHL Plus with Full Text, SportDiscus with Full Text (Ebsco databases); and Scopus. Publication dates were from 1979–2020 across nine different countries resulting in 39 individual cases of stroke with an athlete age range of 14–56 years (95% male). The major inciting event(s) prior to stroke onset were headaches (38.4%), head trauma (30.7%), and neck injury and/or vertebral artery dissection (20.5%). Several sporting activities were represented with American football as the most prevalent (30.7%). In summary, we found that sports with an aspect of impact, collision, or microtrauma can lead to subsequent stroke. These sport-related traumatic events were often difficult to diagnose because of the longer interval before ischemia occurred. Therefore, health care providers should be particularly attuned to the possibility of stroke when evaluating athletes presenting with or without neurological deficit.

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Section: Discussionmentioning

confidence: 97%

Stroke and Athletes: A Scoping Review

Doyle‐Baker

Mitchell

Hayden

2021

IJERPH

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“…Therefore, we advise updating the knowledge of physiotherapists concerning adverse events. Furthermore, although cervical arterial dissection has been documented related to a wide variety exercises [18,[69][70][71], physiotherapists are not accustomed to evaluating cardiovascular parameters [72][73][74], and only 5.3% of the respondents are concerned about the exercises' related risk: considering that 62% of physiotherapists' patients potentially have a history or suffer of cardiac disease, the risk of acute myocardial infarction during exercise is seven times higher than that of sudden cardiac death [75][76][77][78]. Therefore, we advise physiotherapists to consider risk factors and more specific cardiovascular parameters, in their clinical reasoning.…”

Section: Recommendations For Clinical Practicementioning

confidence: 99%

Assessing Cranial Nerves in Physical Therapy Practice: Findings from a Cross-Sectional Survey and Implication for Clinical Practice

et al. 2021

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Background and objective: Serious pathologies of the neck can potentially result in cranial nerve palsy. Knowledge about cranial nerve examination (CNE) seems sparse, and its use is still unknown. We aim to investigate the knowledge, skills, and utilization of CNE of Italian physiotherapists. Materials and Methods: An online cross-sectional survey. Results: 396 completed the survey, reaching the required sample size. Although Italian physiotherapists consider CNE relevant (mean ± SD = 7.6/10 ± 2.0), over half of all responders (n = 229 (57.8%)) were not trained in the fundamentals and around a third did not use it in their daily practice (n = 138 (34.8%)). Additionally, participants were unconfident and insecure in conducting (n = 152 (38.4%) and n = 147 (37.1%)), interpreting (n = 140 (35.4%) and n = 164 (41.4%)), and managing the CNE (n = 141 (35.6%) and n = 154 (38.9%)). Possessing a musculoskeletal specialization was associated with an increased value attributed to clinical practice guidelines and reduced the lack of confidence in conducting, interpreting, and managing the CNE (respectively, n = 35 (25.5%), p = 0.0001; n = 32 (23.4%) p = 0.0002; n = 32 (23.4%) p = 0.0002). Working in a direct access setting significantly increased the considered relevance of guidelines and the concerns about arterial (p = 0.004) and other serious pathologies (p = 0.021). Pain and visual disturbances were considered the main indicators to CNE, demonstrating limited knowledge of signs and symptoms’ indicating CNE. Participants considered specific training in CNE as relevant (mean ± SD = 7.6/10 = 2.1). Conclusions: a substantial proportion of Italian physiotherapists are not schooled in the fundamentals of cranial nerve examination. Given the number of physiotherapists who work in first contact roles, this is a professional concern.

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“…(ii) A sports-related direct −60% in a recent review ( 5)-or indirect blunt trauma of the neck or head preceding the onset of CeAD symptoms. (iii) When sport activity involved jerky, rapid movements; abrupt rotation; triggered reflexive reactions; long-lasting hyperextension; or rapid flexion-extension of the neck or very high blood pressure values and when the neck was rotated with or without extension (5,7). Whereas in some sport activities direct blunt trauma (e.g., combat-sports) or indirect trauma (e.g., golf) or increased intrathoracic pressure with high blood pressure (e.g., weight lifting) may be predominant, a combination of the aforementioned components may be present in other sport activities [e.g., swimming, climbing, or bicycling (7)].…”

Section: Sports-related Ceadmentioning

confidence: 99%

Cervical Artery Dissection and Sports

et al. 2021

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Cervical artery dissection (CeAD) occurring in the context of sports is a matter of concern for CeAD patients. They seek advice on the role of sports in CeAD and on the safety of resuming sports after CeAD. The scarcity of studies and guidelines addressing these issues poses a challenge. We aimed at summarizing the current knowledge about CeAD and sports in order to provide an informed, comprehensive opinion for counseling CeAD patients. We took into account pathophysiological considerations, observations of cases reports, series, and registries, and conclusions by analogy from aortic dissection or inherited connective tissue syndromes. In summary, practicing active sports as the cause of CeAD seems uncommon. It seems recommendable to refrain from any kind of sports activities for at least 1 month, which can be extended in case of an unfavorable clinical or neurovascular course. We recommend starting with sport activities at low intensity—preferably with types of endurance sports—and to gradually increase the pace in an individually tailored manner, taking into circumstances of the occurrences of the CeAD in the individual patient (particularly in relation to sports), the meaning of sports activities for the individual well-being, the presence or absence of comorbidities and of neurological sequela, neurovascular findings, and whether there are signs of an underlying connective tissue alteration. Major limitations and several forms of bias are acknowledged. Still, in the absence of any better data, the summarized observations and considerations might help clinicians in advising and counseling patients with CeAD in clinical practice.

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Vertebral Artery Dissection in Sport: A Systematic Review

Cited by 20 publications

References 105 publications

Stroke and Athletes: A Scoping Review

Stroke and Athletes: A Scoping Review

Assessing Cranial Nerves in Physical Therapy Practice: Findings from a Cross-Sectional Survey and Implication for Clinical Practice

Cervical Artery Dissection and Sports

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