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Advanced Manual Therapy > Cervical Aa. Dissection > Flashcards

Cervical Aa. Dissection Flashcards

1
Q

Vertebral Aa. Anatomy

A
  • arises from the subclavian aa.

Comprised of 4 segments:

  • V1-Extraosseous
  • V2-Foraminal Segment
  • V3-Extraspinal
  • V4-Intradural Segment
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2
Q

V1-Extraosseous

A

origin to the C6 transverse foramen

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3
Q

V2-Foraminal Segment

A

C6-C1 foramina

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4
Q

V3-Extraspinal

A

exit of C1 to foramen; magnum dura

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5
Q

V4-Intradural Segment

A

magnum dura to basilar aa. junction

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6
Q

Describe the age-related changes in the cervical IV disc

A

the cervical vertebral discs become bipartite with age/degeneration

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7
Q

What arteries branch off the vertebral aa. before it joins with the basilar aa.?

A
  • labyrinthine aa.
  • anterior inferior cerebellar aa. (AICA)
  • anterior spinal aa.
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8
Q

Pontine Aa.

A

supplies the pons

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9
Q

Labyrinthine Aa.

A

supplies cranial n. VII and VIII

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10
Q

Anterior and Posterior Inferior Cerebellar Aa.

A

supply the cerebellum

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11
Q

Superior Cerebellar Aa.

A

supplies the cerebellum, pons, and pineal gland

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12
Q

Posterior Cerebral Aa.

A

contributes to the blood supply of the temporal and occipital lobes, thalamus, lentiform nucleus, midbrain, geniculate bodies, pineal gland, choroid plexuses

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13
Q

Anterior Spinal Aa.

A

supplies the anterior 2/3rds of spinal cord

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14
Q

What is the most common vertebral aa. variant?

A

Persistent First Intersegmental Aa.

occurs when the vertebral aa. ascends through the vertebral foramen instead of the transverse foramen

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15
Q

Intimal Tear

A

vessel intima tears, flapping into the lumen

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16
Q

Dissection

A

a defect in the intima causes bleeding into the vessel wall forming a false lumen; flow compromise and possible thrombus formation

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17
Q

What are the three layers of an artery?

A
  • intima
  • media
  • adventitia
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18
Q

Pseudoaneurysms

A

blood escapes through the vessel wall, forming an extravascular hematoma, a cavity can form w/in the hematoma

in some cases this causes obstruction of the lumen, resulting in occlusion by mural thrombosis

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19
Q

Transection

A

most severe; usually fatal

20
Q

What are the cerebrovascular complications of VAD?

A
  • stroke = 63%
  • TIA = 14%
  • Subarachnoid hemorrhage = 10%
21
Q

Vertebral Aa. Lesions

A
  • decreased blood flow not from stretching

- often results from impingement of vessel between C2 transverse foramen exit and C1 lateral mass edge

22
Q

PICA obstruction causes:

A

lateral medullary syndrome infarct

23
Q

Anterior Spinal Aa. causes

A

spinal cord ischemia

24
Q

Vertebral Aa. dissections occur more in _____ patients, while Carotid Aa. dissections occur more in _______ patients

A

older; younger

25
Q

Where is the most common type of extracranial internal carotid dissection?

A

2-3 cm above the bifurcation

26
Q

Lateral Medullary Syndrome (Wallenberg’s)

A
  • usually a result of vertebral aa. origin; less w/ PICA
  • ipsilateral Horner syndrome
  • pain and temperature sensation loss of the face
  • weakness of palate, pharynx, and vocal cords
  • cerebellar ataxia
  • contralateral hemibody pain and temperature loss
27
Q

What are the two imaging modalities listed in the ACR Appropriateness Criteria for suspected cervical aa. dissection?

A

CTA and MRA

28
Q

What is the duration of the onset of S/Sx after Rx?

A
  • immediate = 62.5%
  • 5-30 mins = 12.5%
  • 30 mins - 48 hours = 19%
  • 48 hours to 7 days = 3%
  • more than 1 wk = 1.5%
  • not available = 1.5%
29
Q

Risk of CVA is high in the 1st ___ weeks after CAD

A

two

30
Q

Sx of Cervical Aa Dissection

A
  • headache
  • neck pain
  • visual disturbance
  • dizziness
  • UE paresthesia
  • facial paresthesia
  • LE paresthesia
31
Q

Carotid Aa Dissection usually begins with:

A
  • ipsilateral neck pain or HA
  • partial Horner’s Syndrome
  • typically follows with retinal or cerebral ischemia
32
Q

S/Sx of VAD/CVA

A
  • occipitocervical pain
  • dizziness, vertigo, light-headedness
  • nausea and vomitins
  • numbness, usually hemifacial
  • ataxia, unsteady gait
  • diplopia or other visual deficit
33
Q

Vertebral Aa CVA Presentation

A
  • ipsilateral Horner’s Syndrome
  • ilsilateral limb ataxia
  • contralateral analgesis of trunk and limbs
  • ipsilateral CN IX-Xii abnormalities
34
Q

Horner’s Syndrome

A
  • anisocoria (ipsilateral pupil dilation)
  • miosis (ipsilateral pupil constriction)
  • ptosis (lid droop-Mueller’s muscle weakness)
  • apparent enophthalmos
  • facial anhidrosis and flushing
  • sympathetic loss
35
Q

Crossed Cheiro-oral Syndrome

A
  • sensory disturbance unilateral peri-oral w/ contralateral hand/fingers
  • suggestive of medullary involvement
  • often occurs before Wallenberg syndrome (24-48 hrs.)
  • predictor of CVA
36
Q

Bow Hunter’s Syndrome most often affects which segments?

A

V2 and V3

37
Q

S/Sx of Bow Hunter’s Syndrome

A
  • syncope/near syncope
  • drop attacks
  • vertigo
  • dizziness
  • ataxia
  • impaired vision
38
Q

Etiology of Vertebral Artery Incident

A
  • spontaneous = 43%
  • cervical manipulation = 31%
  • trivial trauma = 16%
  • major trauma = 10%
39
Q

What is the effect of cervical rotation on the vertebral aa?

A

blood flow in the contralateral aa. is reduced; however, the velocity increases d/t the Venturi tube effect

40
Q

What segment of the vertebral aa. is most susceptible to mechanical forces during manipulation?

A

V-3; usually an injury to the intima between C1-C2 which propagates to V-3

41
Q

What is the primary shortcoming of most studies examining the effect of vertebral aa testing on the vessel?

A

none of the studies have actually looked at the vessel’s ability to withstand the HLVA thrust

42
Q

What are the problems with the available evidence on CAD?

A
  • difficult to establish associations in rare events
  • likely to be under-reported
  • data mining and analysis can often identify or predict rare events
  • cannot determine impact and probabilistic causal inference
43
Q

Risk Factors for Cervical Aa CVA

A
  • recent head or neck trauma
  • neck manual therapy
  • recent infection
  • craniocervical vascular anomaly
  • family hx of CVA
44
Q

5Ds And 3Ns

A
  • Diplopia
  • Dizziness
  • Drop Attacks
  • Dysarthria
  • Dysphagia
  • Ataxia
  • Nausea
  • Numbness
  • Nystagmus
45
Q

What are the most frequent symptoms in the clinical presentation of VAD?

A
  • visual disturbance
  • dizziness
  • imbalance
46
Q

T/F: A hypoplastic vertebral artery (HVA) has an increased risk of CVA

A

True

47
Q

What other injuries are associated with VAI in patients following trauma?

A
  • facet dislocation w/ or w/o fxs
  • C1-3 fx
  • Type III odontoid fxs
  • distraction MOI

Advanced Manual Therapy (3 decks)

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