Cervical arterial dissection: an overview and implications for manipulative therapy practice

Thomas, Lucy C. (2015) Cervical arterial dissection: an overview and implications for manipulative therapy practice. Manual Therapy, 21 2-9. doi:10.1016/j.math.2015.07.008


Author Thomas, Lucy C.
Title Cervical arterial dissection: an overview and implications for manipulative therapy practice
Journal name Manual Therapy   Check publisher's open access policy
ISSN 1532-2769
1356-689X
Publication date 2015-07-29
Sub-type Article (original research)
DOI 10.1016/j.math.2015.07.008
Open Access Status Not Open Access
Volume 21
Start page 2
End page 9
Total pages 8
Place of publication London, United Kingdom
Publisher Churchill Livingstone
Collection year 2016
Language eng
Formatted abstract
Introduction: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to minor trauma or infection. The incidence is difficult to determine accurately as not all CAD progress to stroke. CAD is the most catastrophic adverse event associated with cervical manipulative therapy but it is rare. Early features of CAD can mimic a painful musculoskeletal presentation and a patient may present for treatment of neck pain and headache with a dissection in progress. Whether the manipulative technique is responsible for dissection or whether the diagnosis of CAD has been missed is unclear. Identification of individuals at risk, or early recognition of CAD could help expedite medical intervention and avoid inappropriate treatment.

Purpose: The aims of this masterclass are to outline current research into the pathophysiology, aetiology and clinical presentation of CAD, to place the risk in context in a manipulative therapy setting and to discuss its possible clinical recognition.

Implications: For those patients presenting with recent onset, moderate to severe unusual headache or neck pain, clinicians should perform a careful history, in particular questioning about recent exposure to head/neck trauma or neck strain. Cardiovascular factors may not be particularly useful indicators of risk of dissection. Clinicians should also be alert to reports of transient neurological dysfunction such as visual disturbance and balance deficits, arm paraesthesia and speech deficits, as these may be subtle. If clinicians suspect arterial dissection is in progress patients should be urgently referred for medical evaluation.
Keyword Carotid artery
Internal dissection
Manipulation
Neck
Risk factors
Spinal
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Health and Rehabilitation Sciences Publications
 
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