Vertebral Artery

Question 0

What is the course of the vertebral artery?

Answer 0

Subclavian a. -> vertebral a. -> transverse foramen of C6 -> ascends cephalad through foramen from C6-C2 -> posterior aspect of C2 -> superiorlaterally and anteriorly to transverse foramen of C1 -> superiomedially and posteriorly to dura mater/foramen magnum -> circle of Willis

Question 1

Where does the vertebral artery originate?

Answer 1

Subclavian artery
Distal to common carotid
Proximal to thyrocervical trunk

Question 2

How many segments are there considered to be?

Answer 2

4

Question 3

What arteries of the circle of Willis does the vertebral artery form?

Answer 3

Basilar artery

Posterior inferior cerebellar artery

Question 4

What are common anomalies of the vertebral artery?

Answer 4

Uni/bilaterally absent
Diameter
Origin (extradural origin)

Question 5

Rotation of the cervical spine to one spine can cause occlusion to the contra or ipsilateral artery. Can it cause someone to pass out? Why/why not?

Answer 5

No due to the contralateral circulation and supply from carotid

Question 6

What are the two types of vertebral artery dissection?

Answer 6

Subintimal and subadventitial

Question 7

What is the difference between subintimal and subadventitial dissections?

Answer 7

Subintimal balloons into the lumen

Subadventitial balloons extralumenal

Question 8

What are the 5 inherited predisposing factors of VAD?

Answer 8

Marfaan's disease
Elher Danlos Syndrome
Polycystic kidney disease 
Osteogenesis imperfecta
Fibromuscular hyperplasia

Question 9

What are other predisposing factors of VAD?

Answer 9

Migraine
Previous respiratory infection
Hx of other neurological symptoms

Question 10

What are the consequences of hematoma?

Answer 10

Seals of - asymptomatic
Subintimal -> occlusion of vessel -> ischemia/infarction
Subadventitial -> aneurysm -> rupture (subdural heamatoma)
Development of thrombi -> emboli

Question 11

What are the pre-manipulative screening tests for VAD? Are they reliable?

Answer 11

George’s test
Deklynes test
Extension rotation test

No - high % of false negatives and positives

Question 12

What are other signs of VAD?

Answer 12

5 D's, 3N's and A 
Slurred speech
Giddiness
Loss of context in speech
Change in voice patterns
Inappropriate reactions to situations

Question 13

What are the 5 D’s, 3N’s and A?

Answer 13

Dizziness
Drop attacks
Dysarthria
Diplopia
Disphagia
Nausea
Numbness
Nystagmus
Ataxia

Question 14

What are the steps taken when a patient shows signs of possible VAD after an adjustment?

Answer 14

DO NOT READJUST PATIENT
Recognition and documentation of post-adjustment symptoms
Monitor patient for relief/worsening of symptoms
Vital signs and specific neurological response
Transient symptoms - watchful waiting
Consider area adjusted/type/altered approach possible
Development of additional symptoms/mental status
Call emergency services if severe/symptoms worse
Referral to GP if symptoms resolve