Cervical Arterial Dysfunction

Question 1

What is the definition of cervical arterial dysfunction, and the major types?

Answer 1

Cervical arterial dysfunction (CAD) = disruption of the blood vessels supplying the brain.

Can affect either vertebrobasilar artery (posterior supply) or internal carotid artery (anterior supply)

Includes cervical arterial dissection, transient ischaemia, and vertebrobasilar insufficiency

Question 2

What are the primary SSX of cervical arterial dysfunction?

Answer 2

1. acute onset unilateral HA (frontotemporal)
2. acute onset unilateral facial or CX pain
3. dizziness
4. ataxia
5. Horner’s syndrome (full or partial - miosis, ptsosis, loss of facial sweating)
6. changes to speech or vision
7. neuro SSX in limbs
8. drop attacks
9. tinnitus

Question 3

What are the 4 VU clinical guidelines for suspected cervical arterial dysfunction?

Answer 3

1. CAD can present as acute onset Cx pain and/or HA
2. CAD should be considered a DD for acute onset Cx pain of < 1 week
3. if CAD is indicated, follow up with neuro and/or CV exams; and refer if necessary
4. Cx pre-manipulative screening tests should not be used

Question 4

What are the risk factors for CAD?

Answer 4

• family or personal Hx of migraine
• hypertension and/or CV risk factors
• diabetes mellitus
• Cx trauma (minor or major)
• recent respiratory infection
• tobacco & alcohol intake

Question 5

Which clinical exams are always performed to screen for suspected CAD?

Answer 5

1. BP
2. Cranial nerve
3. Propioception & co-ordination

Question 6

Which additional clinical exams are performed to screen for suspected CAD, and in what circumstances?

Answer 6

If hypertension and/or CV risk factors - add CV test

If recent respiratory infection - add respiratory exam

If Cx trauma and/or neuro SSX in limbs and/or ataxia: add Cx instability tests & upper and lower limb neuro tests

Question 7

In which circumstances is a neurological screening of the limbs indicated in suspected CAD?

Answer 7

If there has been a Hx of Cx trauma (minor or major); if ataxia is present, and if neuro SSX in limbs are present

Question 8

Which two arteries supply blood to the brain? Describe their course (briefly)

Answer 8

Internal Carotid Artery:
L: aorta
R: brachiocephalic trunk

common carotid - splits into ICA & ECA at level C4

ICA enters skull through carotid canal & gives off anterior and middle cerebral arteries

Vertebrobasilar:

• from subclavian
• travels through TPs of C6-1
• enters skull through foramen magnum
• gives off posterior inferior cerebellar
• unites to form basilar
• gives off anterior inferior cerebellar, superior cerebellar, and posterior cerebral

Question 9

What branches do the ICA and VBA give off?

Answer 9

ICA - anterior and middle cerebral

VBA - cerebellar arteries (posterior inferior, anterior inferior, superior) & posterior cerebral

Question 10

Which areas of the brain are supplied by the ICA and VBA?

Answer 10

ICA: all of the cerebral cortex except inferior temporal & occipital

VBA: inferior temporal & occipital; brainstem & cerebellum