Flashcards in Cervical Manual Therapy Deck (43)
What percentage of cervical artery dissection cases are of the internal carotid artery?
What percentage of cervical artery dissection cases are of the vertebral artery?
What percentage of cervical artery dissections are classified as spontaneous?
What percentage of cervical artery dissections were associated with trauma/ trivial trauma?
What percentage of cervical artery dissections were associated with cervical spine manipulation?
How often does a stroke occur following cervical spine manipulation?
- Varies from study to study
1:10,000 --> 1:5.85 Million
Is it more dangerous to drive in your car or to recieve a c-spine manipulation?
Driving in car
How likely is riding an airline to be fatal?
How likely is the development of a GI bleed while receiving NSAIDS?
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
Is there more evidence for C-spine manipulation or other therex type techniques for neck pain?
Are mobilizations, traction, PROM, and strengthening risk free?
At which vertebra and above is the vertebral artery most at risk for dissection?
What combination of motions is thought to be the most stressful to the vertebral artery?
- Contralateral rotation with extension
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
Is stroke following dissection of the vertebral artery immediately apparent?
- Not always; it can take time
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
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
Is the Vertebral basilar Artery Insufficiency test valid and reliable?
- Not sensitive or specific
What are the 10 signs of VBI (5 Ds, 3 Ns, 1 H, and 1 A)?
- Drop Attacks
- Hearing Disturbances
What is dysarthria?
- Slurred speech
What is dysphagia?
- Trouble swallowing
Where is numbness typically felt in patients with VBI?
- Around mouth, or one side of the face or body
What may occur instead of a headache if the VBI is sudden or severe?
- Neck pain
What is an example of the type of hearing disturbance that will be heard in a patient with VBI?
What may be the ONLY sign in spontaneous cervical artery dissection?
What artery do VBI screens not assess that is just as commonly dissected as the vertebral?
- The internal carotid
How strong is the evidence supporting the construct validity of the screening tests to predict the occurrence of VBI?
- No evidence
What are 5 signs in the patient's history that are risk factors for VBI?
- Hypertension (>180/100)