Cerebrovascular Blood Flow Assessment Flashcards
How many strokes are there per year in US?
700,000
The third leading cause of death in US?
strokes
What is the #1 cause of nursing home admission?
stroke
What is the #1 risk factor for stroke?
hypertension
What are the two types of stroke?
hemorrhagic and ischemic
What type of stroke has been associated with chiropractic adjustments?
ischemic
What specific ischemia is associated with chiro adjustments?
vertebral artery ischemia
The vertebral artery ischemia affects what part of the brain?
brainstem and cerebellum
Have cervical adjustments been implicated in strokes originating from carotid arteries?
no
The carotid arteries supply which part of the brain?
anterior 2/3 rds
Are vertebral artery strokes common with chiropractic?
no
Injury to the vertebral artery wall may cause what?
vasospasms, dissecting aneurysms, clots, and/or emboli that result in ischemia or occlusion
What can entrap the VA during head rotation and provoke a stroke?
ponticulus ponticus
What is it called when a ponticulus ponticus gets entrapped and causes a stroke?
Bow Hunters stroke
What are some worrisome symptoms suggesting the possibility of cerebrovascular ischemia? *****
sudden, severe, onset of a headache NEVER EXPERIENCED PREVIOUSLY and originating over, behind the ear and down the neck on one side
What are the chances of VBS happening to you?
1 in 25 chiropractors during a 40 year practicing career
What type of adjustments have been involved in the majority of VBS cases?
high velocity low amplitude thrusts
What is the typical age and sex of patients who have experienced VBS?
30-45 year old women
When do the symptoms of VBS appear?
63% began immediately, all but 8% within 24 hours
What are some worrisome immediate or delayed post adjustment symptoms? 5D’s 3N’s
dizziness diplopa dysarthria dysphagia difficult walking nausea/vomiting unilateral facial numbness nystagmus
If you suspect they are stroking what do you look for? STTR
smile (symmetrically) talk (coherently) tongue in cheek raise both arms (if they can't the need emergency care)
Should you readjust the cervical area if adverse symptoms follow an adjustment?
NO
What should you do?
perform noninvasive vascular and neurologic assessment procedures
If symptoms do not subside rapidly then what do you do?
call 911 for transport to hospital
Side effects of adjustments are common in nature but are _____ and ____?
benign and short duration (24 hours or less)
what are reactions in order of prevalence?
headache stiffness local discomfort radiating discomfort fatigue
What has Palmer recommended to assess potential risk and need for further eval?
1) risky ADL, current and past diseases (smoking, fat, alcohol, atherosclerosis, diabetes, HBP, heart/vessel diseases, blood thinners
2) Possible symptoms of TIA (5D’s 3N’s)
3) Physical exam procedures
4) Vertebrobasilar artery maneuver
What are some of the physical exam procedures that can assess potential TIA risk?
measure BP bilaterally
compare carotid pulses
auscultate carotid pulses bilaterally for bruit
What are the 4 things to asses risk?
1) recognize the classic headache pattern
2) recognize typical patient profile
3) recognize assoc. or transient episodes of 5D’s 3N’s
4) perform routine vascular procedures on all patients or at lease when risk factors are present
What is diplopia?
double vision
What is dysarthria?
trouble talking
What is dysphagia?
difficulty swallowing
