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Flashcards in Cervical Manual Therapy Deck (43)
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1

What percentage of cervical artery dissection cases are of the internal carotid artery?

54 %

2

What percentage of cervical artery dissection cases are of the vertebral artery?

46 %

3

What percentage of cervical artery dissections are classified as spontaneous?

61 %

4

What percentage of cervical artery dissections were associated with trauma/ trivial trauma?

30 %

5

What percentage of cervical artery dissections were associated with cervical spine manipulation?

9 %

6

How often does a stroke occur following cervical spine manipulation?

- Varies from study to study
1:10,000 --> 1:5.85 Million

7

Is it more dangerous to drive in your car or to recieve a c-spine manipulation?

Driving in car

8

How likely is riding an airline to be fatal?

1:8 million

9

How likely is the development of a GI bleed while receiving NSAIDS?

4:1,000

10

Is a cervical manipulation or an NSAID more likely to be fatal?

NSAIDS 4 times more risky than the most severe c-spine manip statistics

11

Is there more evidence for C-spine manipulation or other therex type techniques for neck pain?

C-spine manips

12

Are mobilizations, traction, PROM, and strengthening risk free?

- No.

13

At which vertebra and above is the vertebral artery most at risk for dissection?

C2

14

What combination of motions is thought to be the most stressful to the vertebral artery?

- Contralateral rotation with extension

15

What is the mechanism of stroke following a cervical manipulation?

- Stretch/ pinch separates inner and outer lining of the artery leading to an internal bleed
- Thrombus forms --> Dislodges or flakes off to become an embolus
- Travels to small diameter arteries
- Causes ischemia/ infarct

16

Is stroke following dissection of the vertebral artery immediately apparent?

- Not always; it can take time

17

Why is the incidence of manipulation induced stroke difficult to obtain?

- Under-reported in literature
- Delay between manipulation and stroke clouds the correlation and causation
- Dissection may have been in process leading to the practitioner to perform the manipulation

18

How is the Vertebral Basilar Artery Insufficiency test performed?

- Place patient into end-range rotation with some possible distraction and/or extension.
- Hold for 10 seconds

19

Is the Vertebral basilar Artery Insufficiency test valid and reliable?

- Not sensitive or specific

20

What are the 10 signs of VBI (5 Ds, 3 Ns, 1 H, and 1 A)?

- Dizziness
- Drop Attacks
- Diplopia
- Dysarthria
- Dysphagia
- Ataxia
- Nausea
- Numbness
- Nystagmus
- Headache
- Hearing Disturbances

21

What is dysarthria?

- Slurred speech

22

What is dysphagia?

- Trouble swallowing

23

Where is numbness typically felt in patients with VBI?

- Around mouth, or one side of the face or body

24

What may occur instead of a headache if the VBI is sudden or severe?

- Neck pain

25

What is an example of the type of hearing disturbance that will be heard in a patient with VBI?

Tinnitus

26

What may be the ONLY sign in spontaneous cervical artery dissection?

- Pain

27

What artery do VBI screens not assess that is just as commonly dissected as the vertebral?

- The internal carotid

28

How strong is the evidence supporting the construct validity of the screening tests to predict the occurrence of VBI?

- No evidence

29

What are 5 signs in the patient's history that are risk factors for VBI?

- Hypertension (>180/100)
- Migraine
- Smoking
- Trauma
- Ateriosclerosis

30

Should premanipulation tests be performed if there is a storng likelihood of VBI?

- No; refer the patient out