Bilateral Vertebral Artery Dissection After Chiropractic Maneuver

Preul, Christoph; Joachimski, F.; Witte, OW; Isenmann, Stefan

doi:10.1007/s00062-010-0021-x

Cited by 20 publications

(14 citation statements)

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“…In contrast, in our cohort, the VA was affected more frequently. The course of the VA in the lateral vertebral process may account for a preference to dissections [16][17][18]. Thorough MRI and MRA investigations in all patients in the acute phase may be a reason for a high proportion of VA-dissections (n = 43) in the present cohort.…”

Section: Epidemiologymentioning

confidence: 78%

“…In this series, a possibly causing trauma (e.g., car accident, parachute jumping, angiography) was identified in 33.8% of all patients. 25% of dissections classified as traumatic in origin were preceded by chiropractic manoeuvres [18,19]. However, differentiation between spontaneous and traumatic dissection may be difficult in some cases, as it is hard to define which traumata should be considered "adequate" [20].…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

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Dissections of Cervical Arteries – Clinical Presentation, Course, and Therapy in 71 Consecutive Patients of a Single University Centre

Neidhardt¹

2011

TOCCMJ

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Dissections of the cervical arteries are among the most frequent causes of juvenile strokes. The etiology and pathogenesis of spontaneous dissections remain elusive. Best treatment remains to be defined. Here, we analyzed 71 consecutive patients from the Department of Neurology, University Hospital of Jena. We asked if immediate anticoagulation or alternative treatment with ASA would affect outcome. Patients treated initially with i.v. ASA tended to have a better outcome than patients who were anticoagulated (r=0.3; p<0.05). In heparin treated patients, an initial i.v. bolus shortened the interval before the target PTT was reached by 1.3 days (p<0.05), yet did not affect neurological outcome. Low NIHSS (National Institute of Health Stroke Scale) (r=-0.71; p<0.01) and high Barthel scores (r=0,77; p<0.01) at presentation predicted a good outcome. In 14 of 52 patients, low TSH (thyroid-stimulating hormone) indicated hyperthyreosis, while no patient was hypothyreotic. In 33 of 64 patients CRP (C-reactive protein) was elevated. These findings merit validation in larger trials.

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Section: Epidemiologymentioning

confidence: 78%

Section: Aetiology and Pathogenesismentioning

confidence: 99%

Dissections of Cervical Arteries – Clinical Presentation, Course, and Therapy in 71 Consecutive Patients of a Single University Centre

Neidhardt¹

2011

TOCCMJ

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“…Therefore, prognostic factors are difficult to identify. Indicators for putative satisfactory outcome include short duration of basilar occlusion, good collateral circulation, young patient age [11,39], thrombus location (distal better than proximal) [28], and small areas of infarction indicated by minor DWI (diffusion weighed imaging) lesions in MRI [27]. From our patient cohort, we did not succeed in establishing a reliable prognostic score from admission MRI data, owing to varying number, distribution and extent of ischemic lesions, and highly varying extent of clinical impairment that did not correlate with patterns of ischemic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Thrombosis of the basilar artery is a relatively rare yet serious type of ischaemic stroke that causes death in up to 95% of all cases, unless quick and sufficient therapy is provided. Basilar artery thrombosis may be caused by local thrombosis on the basis of a prominent stenosis of the basilar artery, arterio-arterial embolism with an upstream stenosis, or, in even rarer cases, dissection of the vertebral artery, or cardiac/ aortic (arterio-arterial) embolism [39].…”

Section: Introductionmentioning

confidence: 99%

Clinical Diagnostics, Therapy and Outcome After Basilar Artery Thrombosis

Lohse¹,

Preul²

2011

TOCCMJ

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Acute basilar artery occlusion is a relatively rare but life threatening condition requiring rapid diagnosis and treatment. The circumstances and predictive value for outcome in these patients are not well documented. 88 patients with basilar artery occlusion treated in the Department of Neurology at Jena University Hospital from 1998 to 2007 were identified and studied. Of these, 45 were males and 43 females, aged between 20 and 92 years (median, 63 years). In 60.2%, MRI with MR angiography led to the diagnosis; 13.6% of all cases were diagnosed by cranial CT. 45 patients were treated with thrombolytic therapy with rt-PA (44/45) or urokinase (1/45; in 1999). Out of 45 patients, eight (17.7%) initially received systemic (i.v.) thrombolytic treatment. Recent research has suggested that for patients with unambiguous basilar artery thrombosis, the only promising treatment option is early thrombolytic treatment. The major clinical goal is to enable patients to live an independent life after the acute phase and, if required, rehabilitation. Consequently, this challenges the concept of a "thrombolysis at all costs" approach, especially in case of multi-morbidity, unidentifiable time frames, and comatose patients with regards to possible poor functional prognosis. An adequate therapy in the sense of an adaptable scheme, starting with immediate maximum therapy following diagnosis, and with defined decision points for possible therapeutic limitations at later stages of the disease course after ensuring poor prognosis may require further testing, depending on clinical conditions and the patients' documented, or presumable wishes.

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“…Chiropraktische Manöver mit impuls-und ruckartigen passiven Bewegungen scheinen insgesamt das Dissektionsrisiko der A. vertebralis zu erhöhen [50,52,57,58]. Geschätzt tritt eine Dissektion mit einer Häufigkeit von 1 in 400 000 bis 1 Million Manipulationen auf [53].…”

Section: Physiotherapieunclassified

Zervikale Radikulopathie

Pohl¹,

Back²,

Leimert³

et al. 2018

Akt Neurol

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Zusammenfassung Hintergrund Die zervikale Radikulopathie (ZR) ist ein relativ häufiges Krankheitsbild, welches in sehr vielen Bereichen der Medizin vorkommt und einen interdisziplinären Behandlungsansatz erfordert. Obwohl das Leitsymptom der Schmerz ist, weist die ZR einige Besonderheiten auf, denen die Deutsche Gesellschaft für Neurologie in einer eigenen Leitlinie Rechnung trägt. Das wesentliche Ziel dieser Leitlinie war es, den aktuellen Wissensstand zur Therapie der ZR zu vermitteln. Die vorliegende Leitlinie bezieht sich ausschließlich auf die degenerativ bedingten ZR. Methodik Der Leitlinie liegt eine Recherche von Leitliniendatenbanken und Medline zugrunde. Unter der Moderation durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erfolgte die Konsensfindung mittels eines nominalen Gruppenprozesses und des Delphi-Verfahrens. Aufgrund des interdisziplinären Behandlungsansatzes wurde das Leitliniengremium aus Experten verschiedener ärztlicher (Neurologie, Orthopädie, Unfallchirurgie, Neurochirurgie, Schmerztherapie, Physikalische und Rehabilitative Medizin und Manuelle Medizin) und therapeutischer Fachdisziplinen (Ergotherapie, Physiotherapie) und unter Beteiligung der Schmerz-Selbsthilfe (Deutsche Schmerzliga) gebildet. Ergebnisse Hinsichtlich der Evidenzbewertung der Literatur ist festzustellen, dass die Datenlage zur Frage des optimalen Vorgehens bei ZR sehr heterogen ist. Die Anwendung von Physiotherapie in Kombination von manueller Therapie und Bewegungsübungen sowie bestimmte operative Verfahren bei ZR sind dagegen evidenzbasiert. Starker Konsens besteht bei den beteiligten Fachgesellschaften, dass das primäre Vorgehen in aller Regel konservativ ist. Hier werden Physiotherapie in Kombination von manueller Therapie, Ergotherapie zur Stärkung der Alltagskompetenz, frühzeitige Schmerztherapie, kurzzeitige intermittierende Ruhigstellung durch das Tragen einer Halskrause und eine periradikuläre Infiltrationstherapie empfohlen. Eine Operation sollte bei therapierefraktärem Schmerzsyndrom nach Ausschöpfung der konservativen Maßnahmen spätestens 6 Monate nach Symptombeginn dem Patienten empfohlen werden. Bei lateralen und intraforaminalen Bandscheibenvorfällen können als Operationsverfahren eine ACDF („anterior cervical discectomy with fusion“) oder eine PCF („posterior cervical foraminotomy“) durchgeführt werden. Das bevorzugte Verfahren ist hier im Einzelfall zu wählen. Bei medianen und paramedianen Bandscheibenvorfällen soll der ventrale Zugang gewählt werden. Schlussfolgerung Die Diagnose einer ZR beruht auf der Anamnese und der neurologischen Untersuchung und soll durch eine bildgebende Methode bestätigt werden. Bei Fehlen behindernder Ausfälle soll das Vorgehen primär konservativ und bei rasch progredienten Paresen primär operativ sein. Bei Einhalten der in der Leitlinie aufgeführten Empfehlungen haben die Schmerzen bei ZR eine günstige Prognose.

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Bilateral Vertebral Artery Dissection After Chiropractic Maneuver

Cited by 20 publications

References 20 publications

Dissections of Cervical Arteries – Clinical Presentation, Course, and Therapy in 71 Consecutive Patients of a Single University Centre

Dissections of Cervical Arteries – Clinical Presentation, Course, and Therapy in 71 Consecutive Patients of a Single University Centre

Clinical Diagnostics, Therapy and Outcome After Basilar Artery Thrombosis

Zervikale Radikulopathie

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