Vetebral Artery Flashcards
Percentage of Blood to the Brain Supplied by Vertebral Artery?
20%
VBA System
2 Vertebral Arteries and 1 Basilar Artery
Basilar Artery
Formed by the two Vertebral Arteries joining each other at midline
Proximal Portion
First Portion
From Subclavian Artery to C6
Transverse Portion
Second Portion
From C6 to C2
Prone to compression from osteophyte formation
Suboccipital Portion
Third Portion
From C2 to Occiput
Vulnerable to compression and stretching at C1-C2 with rotation
Four Parts of Suboccipital Portion
- Within the transverse foramen of C2
- Between C2 and C1
- In the transverse foramen of C1
- Between the posterior arch of the atlas and entry into foramen magnum
Intracranial Portion
Fourth Portion
From foramen magnum to Basilar Artery at the lower border of pons
Prone to artherosclerotic plaques and stenosis
Branches of Vertebral Artery
- Meningeal Branch - Supply bone and dura matter
- Anterior Spinal Artery
- Posterior Spinal Artery
- Muscular Branch - Supply deep Suboccipital muscles
- Posterior Inferior Cerebellar Artery
Vertebrobasilar Insufficiency (VBI) due to
- Atherosclerotic involvement
- Sickle cell disease
- RA
- Arterial Fibroplasias
- Arteriovenous fistula
- Congenital Syndromes
VBI External Causes
- Extracranial Compression
- Hyperextension of neck with or without rotation and side-bending
VBI Internal Causes
- Atherosclerosis
- Thrombosis
- Arterial Fibrodysplasia
- Arteriovenous Fistulas - Abnormal connection or passageway between an artery and a vein
Clinical Manifestations of VBI
- 5 Ds A 3 Ns
- Headache
- Wallenberg/Horner Syndrome
- Paraesthesia
- Upper Motor Neuron signs
5 Ds A 3 Ns
- Diplopia
- Dizziness
- Drop Attacks
- Dysphagia
- Dysarthria
- Ataxia
- Nausea
- Numbness
- Nystagmus
Stroke Risk Factors
- Hypertension
- Diabetes
- Family history
- Smoking
- BMI > 30
- Poor diet
- Upper cervical instability
Incidence of Cervical Manipulation Causing VA Stroke
1/100,000
Examination of the VA
Hold pre-mobilization position for 10 seconds
Major Red Flags for VA Stroke
- Worst Headache of life
- Different headache than normal
- Worst neck pain
- Dizziness
Horner’s Syndrome
Decreases pupil size, droopy eyelid, and decreased sweating on affected side
Premanipulative Position Test
- Side-bending, rotation, and extension
- Look for symptoms
- Hold position for 10 seconds
Avoid When Performing Cervical Manipulation
- Excessive Rotation
- Non physiological movements
- Aggressive forceful manoeuvres
Absolute Contraindications for Manual Therapy
- Infection
- Acute circulatory problems
- Malignancy
- Open wounds
- Recent fracture
- Hematoma
- Inappropriate end feel
- Diabetes
- Severe pain/extensive radiation of pain
Relative Precautions for Manual Therapy
- Joint inflammation
- RA
- Neurological signs
- Osteoporosis
- Pregnancy
- Dizziness
- Steroid use
