Vertebral Artery

Question 1

What percent of the brain does the VA supply?

Answer 1

20%

Question 2

4 portions of Vertebral Artery

Answer 2

1. Proximal
2. Transverse
3. Suboccipital
4. Intracranial

Question 3

Proximal Portion of Vertebral Artery

Answer 3

Runs from subclavian artery to entry of cervical spine - usually C6

Question 4

Transverse Portion

Answer 4

Runs from C6 to transverse foramen of C2

Close to uncinate processes

Question 5

Suboccipital Portion

Answer 5

exit at C2 to penetration into spinal canal. Most vulnerable to compression and stretching.

Question 6

Intracranial Portion

Answer 6

runs from foramen magnum to the basilar artery at the lower border of the pons

Question 7

Main cause of damage and occlusion of the vertebral arteries

Answer 7

Because of the close proximity of the VA and the bony/ligamentous structures of the cervical spine

Question 8

Most common mechanism for a non-penetrating trauma injury to the VA

Answer 8

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

Question 9

Klippel-Trenaunay Syndrome

Answer 9

A condition that affects the development of blood vessels, soft tissues, and bones

Question 10

Common Causes of VA insufficiency

Answer 10

Atherosclerosis
Sickle Cell Disease
RA
Arterial Fibroplasias
Ateriovenous fisula
Congenital Syndromes

Question 11

Clinical Manifestations of VBI

5 D’s And 3 N’s

Answer 11

Dizziness
Drop Attacks
Diplopia
Dysarthria
Dysphagia/Dysphasia

Ataxia

Numbness
Nausea
Nystagmus

Question 12

Other Clinical Manisfestations of VBI

Answer 12

Tinnitus
Headache
Wallenberg, Horner Syndromes
Paresthesia
Periodic LOC
Hyperreflexia
Clonus
Gait ATaxia
\+ Babinski, +Hoffman
etc.

Question 13

Major Risk Factors for Stroke

Answer 13

HTN
Hypercholesterolemia
Hyperlipidemia
Diabetes
Family History
Smoking
BMI >30
Repeated/Recent injury
Upper cervical instability

Question 14

Minor Risk Factors to Stroke

Answer 14

Estrogen-Based Contraceptive
Hormone replacement therapy
Infection
Poor Diet
RA
Blood-Clotting Disorder
Firbomuscular dysplasia
Hypermobility
Erectile Dysfunction
BMI 25-29

Question 15

Imaging Studies

Answer 15

1. ) Conventional Angiography (gold standard)
2. ) Magnetic Resonance Angiographic (MRA, replacing as gold standard)
3. ) Doppler Sonography

Question 16

All patients with neck pain should:

Answer 16

1. ) Volunteer a comprehensive history to clinician
2. ) Subjective Screening examination for VBI
3. ) Evaluated for ability to perform cervical AROM

Question 17

Risk of cauda equina syndrome from lumbar manipulation?

Answer 17

1 in 100 million manipulations

Higher associated risk with nonsteroidal anti-inflammatory drugs

Question 18

How long should you maintain the immediate pre-mobilization position to test the verterbobasilar system?

Answer 18

minimum of 10 seconds

Question 19

What should you be checking while testing the VA?

Answer 19

Eye’s for Nystagmus
Pupil size
Quality of speech
any changes in symptoms, no matter how insignificant

Question 20

Horner’s Syndrome

Answer 20

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

Question 21

In order to perform SMT on the cervical spine, PT should be trained in proper techniques that avoid:

Answer 21

• Excessive Rotation
• Non physiological movement in the joints
• Aggressive forceful maneuvers, gradually build from gentle mobs to higher amplitude/velocity mobs

Question 22

Absolute Contraindications for OMT

Answer 22

Infection
Acute Circulatory Problems
Malignancy
Open Wounds
Hematoma
Recent Fracture
Hypersensitivity to the skin
Inappropriate end feel
Advanced Diabetes
Cellulitis
Severe Pain
Extensive radiation of pain

Question 23

Relative Precautions to OMT

Answer 23

Joint inflammation effusion
RA
Neurological Signs
Osteoporosis
Pregnancy
Dizziness
Steroid/anticoagulant therapy