12/13/2023 0 Comments Torn pica artery![]() Radiographic featuresĭissections are mostly located in the pars transversaria segment (V2) ~35% or in the atlas loop segment (V3) ~34% 2,3,11. Chiropractors have dismissed this association on the grounds that dissection causes neck pain and results in patients seeking out chiropractic manipulation ref. Although as yet there is no conclusive evidence of a direct causal link between the two, an increased association between patients who present with cervical dissections and preceding neck manipulations has been established, which has led some medical associations to suggest a cautionary link based on plausibility and limited established benefits of neck manipulation 14-17. The link between chiropractic neck manipulation and cervical artery dissection (both the carotid artery and vertebral artery) has been long suspected and has been the source of much litigation and heated debates. EtiologyĪntecedent neck manipulation or other sudden movements 5,10 When a tear breaches the aforementioned subendothelial elastic layer, then there is little tissue preventing extension into the subarachnoid space, thus accounting for the very high rate of subarachnoid hemorrhage. This fundamental difference accounts for the markedly different natural history of intracranial arterial dissections compared to their extracranial counterparts. Although the tunica media and tunica adventitia are present, they are only a third as thick as their extracranial counterparts, with the vast majority of elastic fibers located in a subendothelial elastic lamina. In intracranial dissection, there is a high risk of subarachnoid hemorrhage (up to 50% for vertebrobasilar dissections 3) on account of the anatomy of intracranial arteries. As the blood expands the wall, it compromises the lumen resulting in stenosis or occlusion. PathologyĪs with other arterial dissections, blood enters the wall of the artery through a tear in the intima and dissects along the intima-media plane. Other presentations include spinal cord infarction and even cervical nerve root impairment 1. Intradural extension is quite common, with a high frequency of subarachnoid hemorrhage (SAH) 13. TIA or stroke) manifesting as nausea, ataxia, dysarthria, lateral medullary syndrome, or even collapse and coma 11,13. Patients present with a variety of signs and symptoms, most frequently with neck pain and headache (typically occipital) as well as posterior fossa ischemic events (e.g. They are typically encountered in a somewhat younger cohort than internal carotid artery dissections 135. Vertebral artery dissections have an incidence of 1-5 per 100,000 10,11. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |