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Flashcards in Cervical Aa. Dissection Deck (47):
1

Vertebral Aa. Anatomy

- arises from the subclavian aa.

Comprised of 4 segments:
- V1-Extraosseous
- V2-Foraminal Segment
- V3-Extraspinal
- V4-Intradural Segment

2

V1-Extraosseous

origin to the C6 transverse foramen

3

V2-Foraminal Segment

C6-C1 foramina

4

V3-Extraspinal

exit of C1 to foramen; magnum dura

5

V4-Intradural Segment

magnum dura to basilar aa. junction

6

Describe the age-related changes in the cervical IV disc

the cervical vertebral discs become bipartite with age/degeneration

7

What arteries branch off the vertebral aa. before it joins with the basilar aa.?

- labyrinthine aa.
- anterior inferior cerebellar aa. (AICA)
- anterior spinal aa.

8

Pontine Aa.

supplies the pons

9

Labyrinthine Aa.

supplies cranial n. VII and VIII

10

Anterior and Posterior Inferior Cerebellar Aa.

supply the cerebellum

11

Superior Cerebellar Aa.

supplies the cerebellum, pons, and pineal gland

12

Posterior Cerebral Aa.

contributes to the blood supply of the temporal and occipital lobes, thalamus, lentiform nucleus, midbrain, geniculate bodies, pineal gland, choroid plexuses

13

Anterior Spinal Aa.

supplies the anterior 2/3rds of spinal cord

14

What is the most common vertebral aa. variant?

Persistent First Intersegmental Aa.

occurs when the vertebral aa. ascends through the vertebral foramen instead of the transverse foramen

15

Intimal Tear

vessel intima tears, flapping into the lumen

16

Dissection

a defect in the intima causes bleeding into the vessel wall forming a false lumen; flow compromise and possible thrombus formation

17

What are the three layers of an artery?

- intima
- media
- adventitia

18

Pseudoaneurysms

blood escapes through the vessel wall, forming an extravascular hematoma, a cavity can form w/in the hematoma

in some cases this causes obstruction of the lumen, resulting in occlusion by mural thrombosis

19

Transection

most severe; usually fatal

20

What are the cerebrovascular complications of VAD?

- stroke = 63%
- TIA = 14%
- Subarachnoid hemorrhage = 10%

21

Vertebral Aa. Lesions

- decreased blood flow not from stretching
- often results from impingement of vessel between C2 transverse foramen exit and C1 lateral mass edge

22

PICA obstruction causes:

lateral medullary syndrome infarct

23

Anterior Spinal Aa. causes

spinal cord ischemia

24

Vertebral Aa. dissections occur more in _____ patients, while Carotid Aa. dissections occur more in _______ patients

older; younger

25

Where is the most common type of extracranial internal carotid dissection?

2-3 cm above the bifurcation

26

Lateral Medullary Syndrome (Wallenberg's)

- usually a result of vertebral aa. origin; less w/ PICA
- ipsilateral Horner syndrome
- pain and temperature sensation loss of the face
- weakness of palate, pharynx, and vocal cords
- cerebellar ataxia
- contralateral hemibody pain and temperature loss

27

What are the two imaging modalities listed in the ACR Appropriateness Criteria for suspected cervical aa. dissection?

CTA and MRA

28

What is the duration of the onset of S/Sx after Rx?

- immediate = 62.5%
- 5-30 mins = 12.5%
- 30 mins - 48 hours = 19%
- 48 hours to 7 days = 3%
- more than 1 wk = 1.5%
- not available = 1.5%

29

Risk of CVA is high in the 1st ___ weeks after CAD

two

30

Sx of Cervical Aa Dissection

- headache
- neck pain
- visual disturbance
- dizziness
- UE paresthesia
- facial paresthesia
- LE paresthesia

31

Carotid Aa Dissection usually begins with:

- ipsilateral neck pain or HA
- partial Horner's Syndrome

- typically follows with retinal or cerebral ischemia

32

S/Sx of VAD/CVA

- occipitocervical pain
- dizziness, vertigo, light-headedness
- nausea and vomitins
- numbness, usually hemifacial
- ataxia, unsteady gait
- diplopia or other visual deficit

33

Vertebral Aa CVA Presentation

- ipsilateral Horner's Syndrome
- ilsilateral limb ataxia
- contralateral analgesis of trunk and limbs
- ipsilateral CN IX-Xii abnormalities

34

Horner's Syndrome

- anisocoria (ipsilateral pupil dilation)
- miosis (ipsilateral pupil constriction)
- ptosis (lid droop-Mueller's muscle weakness)
- apparent enophthalmos
- facial anhidrosis and flushing
- sympathetic loss

35

Crossed Cheiro-oral Syndrome

- sensory disturbance unilateral peri-oral w/ contralateral hand/fingers
- suggestive of medullary involvement
- often occurs before Wallenberg syndrome (24-48 hrs.)
- predictor of CVA

36

Bow Hunter's Syndrome most often affects which segments?

V2 and V3

37

S/Sx of Bow Hunter's Syndrome

- syncope/near syncope
- drop attacks
- vertigo
- dizziness
- ataxia
- impaired vision

38

Etiology of Vertebral Artery Incident

- spontaneous = 43%
- cervical manipulation = 31%
- trivial trauma = 16%
- major trauma = 10%

39

What is the effect of cervical rotation on the vertebral aa?

blood flow in the contralateral aa. is reduced; however, the velocity increases d/t the Venturi tube effect

40

What segment of the vertebral aa. is most susceptible to mechanical forces during manipulation?

V-3; usually an injury to the intima between C1-C2 which propagates to V-3

41

What is the primary shortcoming of most studies examining the effect of vertebral aa testing on the vessel?

none of the studies have actually looked at the vessel's ability to withstand the HLVA thrust

42

What are the problems with the available evidence on CAD?

- difficult to establish associations in rare events
- likely to be under-reported
- data mining and analysis can often identify or predict rare events
- cannot determine impact and probabilistic causal inference

43

Risk Factors for Cervical Aa CVA

- recent head or neck trauma
- neck manual therapy
- recent infection
- craniocervical vascular anomaly
- family hx of CVA

44

5Ds And 3Ns

- Diplopia
- Dizziness
- Drop Attacks
- Dysarthria
- Dysphagia
- Ataxia
- Nausea
- Numbness
- Nystagmus

45

What are the most frequent symptoms in the clinical presentation of VAD?

- visual disturbance
- dizziness
- imbalance

46

T/F: A hypoplastic vertebral artery (HVA) has an increased risk of CVA

True

47

What other injuries are associated with VAI in patients following trauma?

- facet dislocation w/ or w/o fxs
- C1-3 fx
- Type III odontoid fxs
- distraction MOI