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MSK II > Vertebral Artery > Flashcards

Vertebral Artery Flashcards

1
Q

Vertebral Artery supplies what percentage of blood to the brain?

A

20%

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2
Q

Vertebral Artery originates from what artery?

A

Subclavian Artery

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3
Q

The vertebrobasilar artery system consists of what three vessels?

A

2 vertebral arteries

1 basilar artery

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4
Q

Two vertebral arteries come together at the midline to form what artery?

A

Basilar artery

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5
Q

Portion of vertebral artery that originates at subclavian artery to point of entry to cervical spine.

A

Proximal portion. VA enters the transverse foreman of C6 in most people

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6
Q

2nd portion of VA runs from C6 to transverse foramen of C2

A

Transverse portion. Surrounded by periosteal sheath in transverse canal

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7
Q

Complications in Transverse portion

A

Prone to compression from osteophyte formation. Subluxation from facet joint. Adjacent to anterior spinal roots. VA close in proximity to uncinate processes of each vertebral body.

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8
Q

Portion that exits tat the axis (C2) to its point of penetration into the spinal canal

A

Suboccipital portion

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9
Q

4 divisions of the suboccipital portion

A
  1. Within transverse foramen of C2
  2. Btw C2 and C1
  3. In the transverse foramen of C1
  4. Btw posterior arch of atlas and entry into foramen magnum
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10
Q

Where is VA most vulnerable to compression and stretching

A

At level of C1-C2 with cervical rotation

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11
Q

Suboccipital portion VA vulnerable to impingement from what?

A
  1. Cervical extension at the CV joints
  2. Excursion of the transverse mass of C1 during rotation
  3. Ossification of the atlantoaxial membrane
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12
Q

Portion of VA from foramen magnum to formation of the basilar artery at the lower border of the pons

A

Intracranial portion

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13
Q

Intracrnial portion of the VA is prone to what mechanical obstructions?

A

atherosclerotic plaques and stenosis

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14
Q

Branches of the VA

A
  1. Meningeal Branch:
  2. Anterior Spinal Artery
  3. Posterior Spinal Artery
  4. Muscular Branches
  5. Posterior Inferior Cerebellar Artery
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15
Q

What does the meningeal branch of the VA supply?

A

Bone and dura mater (cerebellar fossa)

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16
Q

Vertebrobasilar Insufficiency

A

Damage and occlusion of vertebral arteries felt to occur because close proximity of VA and bony and ligamentous structures of the cervical spine.

17
Q

Additional Reasons for vertebrobasilar insufficiency

A
  1. Atherosclerotic involvement of the artery
  2. Sickle cell disease
  3. RA
  4. Arterial fibroplasias
  5. Arteriovenous fistula
  6. Number of congenital syndromes
18
Q

Most common mechanism for non-penetrating trauma injury to VA

A

Hyperextension of the neck, with or without cervical rotation or SB

19
Q

VBI - Internal Causes

A
  1. Atherosclerosis
  2. Thrombosis
  3. Arterial fibrodysplasia
  4. Arteriorvenous Fistulas (abnormal connection or passageway btw artery and vein)
  5. Klippel-Trenaunay Syndrome
20
Q

Klippel Trenaunay Syndrome

A

Condition that affects development of blood vessels, soft tissue, and bones

21
Q

Clinical Manifestations of VBI

A
  1. Dizziness/vertigo
  2. Drop attacks
  3. Diplopia
  4. Dysarthria
  5. Dysphagia
  6. Nausea
  7. Numbness
  8. Nystagmus
  9. Tinnitus
  10. HA
  11. Gait ataxia
  12. Clonus
  13. Hyperreflexia
    • babinski
    • Hoffman or Oppenheimm Sign
  16. Hemifacial paralysis
  17. Periodic LOC
22
Q

Major Risk factors for Arterial Intimal Damage (stroke)

A
  1. Hypertension (BP > 140/90)
  2. Hypercholesterolemia
  3. Hyperlipidemia
  4. Diabetes
  5. Family history of myocardial infarct, anginaTIA
  6. Smoking
  7. BMI > 30
  8. Repeated/recent injury (including repeated manipulations)
  9. Upper cervical instability
23
Q

Minor Risk factors for Arterial Intimal Damage (stroke risk)

A
  1. Estrogen-based contraceptive
  2. Hormone replacement therapy
  3. Infection (systemic)
  4. Poor diet
  5. RA or other connective tissue syndrome
  6. Blood-clotting disorder
  7. Fibromuscular dysplasia
  8. Hypermobility
  9. Erective dysfunction
  10. BMI 25-29
24
Q

Imaging Studies VA

A
  1. Conventional angiography = gold standard
  2. Magnetic resonance angiographic (MRA)
  3. Doppler Sonography
25
Q

Conventional Angiography

A

Gold standard. Shows arterial lumen. Allows extensive characterization of dissection of Vas

26
Q

Magnetic Resonance Angiographic (MRA)

A

Less invasive. Replacing conventional angiography as gold standard. MRA highly sensitive and specific in identifying stenosis and occlusions

27
Q

Doppler Sonography

A

Allows direct visualization of vascular tree. Assesses blood flow velocity and pressure waveforms

28
Q

Suspect possible subdural hematoma?

A

Worst headache of my life

29
Q

Examination of VA

A

5 Ds And 3 Ns.

  1. stop test if pt. doesn’t feel good.
  2. observe for changes in pupil size, nystagmus, speech,
30
Q

Horner’s Syndrome

A

Results in decreased pupil size, a drooping eyelid, and decreased sweating of the affected side of your face

31
Q

No neck pain/HA then have thunderclap onset of worst HA/pain of life?

A

Signs of stroke

32
Q

Two strongest risk factors for stroke?

A

HA and dizziness

33
Q

SMT on cervical Spine? (Avoid)

A

Avoid…

  1. Excessive rotation
  2. Non physiological movements in joints
  3. Agressive forceful maneuvers, instead gradually build rom gentle mobilization to higher amplitude and velocity mobilizations
34
Q

Absolute contraindications to manual therapy

A 
Infection
Acute circulatory problems
malignancy
open wounds
recent fractures
hematomas
hypersensitivity to skins
inappropriate end feels
advanced diabetes
cellulitis
severe pain
extensive radiation of pain
35
Q

Relative Contraindications to MT

A 
Joint Inflammation effusion
RA
Neurological signs
Osteoporosis
Pregnancy
Dizziness
Steroid or anticoagulant therapy

MSK II (4 decks)

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