Vascular pathologies of the neck

Question 1

Why are they important to know about

Answer 1

important to know about because most vascular pathologies present with pain in the neck to begin with, and neurological symptoms develop later

Question 2

What are Vascular pathologies of the neck

Answer 2

They are dissections of the cervical vessels of concern are extremely rare and unpredictable

Question 3

What are the most common types of vascular disease affecting cervical arteries

Answer 3

atherosclerotic-based pathologies like thrombotic and embolic events, aneurisms

Question 4

Incidence of internal carotid artery dissections (ICA) and Vertebral artery dissections

Answer 4

ICA are more common, they are likely to occur in the 34-54 age range
VAD occur more in older groups >55

Question 5

Symptoms of dissection and non-dissection CAD events

Answer 5

Acute onset of unilateral cervical spine pain: headaches <1/52 duration are most common presentations of a dissecting cervical artery
Acute onset of occipital, frontal, suborbital or temporal headache- Severe (typically throbbing in nature- unlike any normal headache

Question 6

Pain presentation- Vertebral artery

Answer 6

Ipsilateral posterior upper cervical pain and occipital headache

Question 7

Pain presentation- ICA

Answer 7

Ipsilateral frontal temporal headache and upper cervical/mid cervical pain, facial pain

Question 8

S and S- Carotid artery

Answer 8

Causes: Atherosclerosis, stenotic, thrombotic, aneurysmal, dissection
S&S- Carotidynia (pain in face and neck), cranial nerve dysfunction/palsy, Horners syndrome, TIA/stroke

Question 9

S and S- VA

Answer 9

Causes: Atherosclerosis/dissection
S&S= neck pain, occipital headache, cranial nerve palsy, TIA, stroke

Question 10

horners syndrome- symptoms

Answer 10

Miosis (a constricted pupil), partial ptosis (a weak/droopy eyelid), anhydrosis (decreased sweating), enophthalmos (inset eyeball
Occurs in 82% of patients with ICA

Question 11

S and S- Temporal artery

Answer 11

Cause: giant cell arteritis
temporal pain (headache), scalp tenderness, jaw and tongue claudication
Diplopia or vision loss

Question 12

S and S- Cerebral vessels

Answer 12

Reversible cerebral vasoconstriction syndrome (RCVS)- Severe thunderclap headaches

Question 13

Symptoms of all vascular pathologies of the neck- dizziness

Answer 13

Dizziness- Vertigo, short-term memory loss/nausea/vomiting, light headiness, spinning in head (vestibular dysfunction), spinning of room (cerebellar dysfunction)

Question 14

Symptoms of all vascular pathologies of the neck- other

Answer 14

Paraesthesia or weakness in UL/LL
Ataxia
Nausea
Drowsiness
Confusion
Loss of consciousness

Question 15

Cranial nerve symptoms

Answer 15

Visual disturbances- double vision/loss of vision, recent reading difficulties, recent alteration to eye movement,
facial palsy
Dysphasia/dysarthria/aphasia/ dysphagia
smell/hearing

Question 16

Risk factors for vascular pathologies

Answer 16

recent trauma 40-64% dissection event: sneezing or sproting activities, RTI, unaccustomed heavy exercise, Overweight
Migrains
Vascular anomaly
Recent upper and/or lower respiratory infection

Question 17

Risk factors in order of most to least relevant- Dissection events

Answer 17

Recent trauma, vascular anomaly, current or past smoker, migraine, high total cholesterol, recent infection, hypertension, oral contraception, family history of stroke

Question 18

Risk factors in order of most to least relevant- non dissection event

Answer 18

current or past smoker, hypertension, high cholesteral
migraine, vascular anomaly, family history of stroke, oral contraception, recent infection, recent trauma

Question 19

Examination

Answer 19

Assessment of BP, cranial nerve assessment and eye examination, assessment of peripheral nerves and for a UMN lesion, vessel palpation or auscultation (look for lump/ asymmetry between left and right vessels) , proprioception and co-ordination testing
REFER ON