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Fujiwara G, Oka H, Fujii A. In-hospital recurrence and functional outcome between ischemic stroke caused by intracranial arterial dissection and intracranial atherosclerosis: Retrospective cohort study of the nationwide multicenter registry. J Stroke Cerebrovasc Dis 2023; 32:107212. [PMID: 37331251 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) are often difficult to differentiate, and studies on their background factors and prognosis are scarce. Information on prognosis, including recurrence, is necessary for stroke care, and clarification of epidemiological and clinical differences between the two diseases is important for appropriately handling their heterogeneity. This study aimed to determine the association of ICAD and ICAS with in-hospital recurrence and prognosis and compare their background and clinical findings. METHODS In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database. Adults with ischemic stroke caused by ICAD or ICAS were included in this study. Patients' backgrounds and clinical findings were compared between the ICAD and ICAS groups. The outcome showed an association of ICAD with in-hospital recurrence of ischemic stroke and poor functional outcome relative to ICAS. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) for ICAD with 95% confidence intervals (CIs) for each outcome. RESULTS Among 15,622 patients registered in the Saiseikai Stroke Database, 2,020 were enrolled (ICAD group: 89; ICAS group: 1,931). In the ICAD group, 65.2% of the patients were aged <64 years. Vascular lesion location was more common in ICAD with the vertebral artery [42 (47.2%)], anterior cerebral artery [20 (22.5%)], and middle cerebral artery (MCA) [16 (18.0%)], and in ICAS with MCA 1046 (52.3%). Multivariable logistic regression analyses of the association between ICAD and in-hospital recurrence and poor functional outcome yielded a crude OR (95% CI) of 3.26 (1.06-9.97) and 0.97 (0.54-1.74), respectively, relative to ICAS. CONCLUSION ICAD was associated with a higher in-hospital recurrence than ICAS; however, there was no significant difference in prognosis between the two groups. Differences in background characteristics and vessel lesions may be of interest in these two diseases.
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Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
| | - Akihiro Fujii
- Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
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2
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Arning C, Hanke-Arning K, Eckert B. The Clinical Features of Dissection of the Cervical Brain-Supplying Arteries. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:581-587. [PMID: 35734920 PMCID: PMC9749844 DOI: 10.3238/arztebl.m2022.0238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Dissections of the cervical brain-supplying arteries are a leading cause of ischemic stroke in young adults, with an annual incidence of 2.5-3 / 100 000 for carotid artery dissection and 1-1.5 / 100 000 for vertebral artery dissection. It can be assumed that many cases go unreported. We present the clinical features here to help physicians diagnose this disease entity as rapidly as possible. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed. RESULTS Spontaneous dissection of the internal carotid or vertebral artery is characterized by a hematoma in the vessel wall. It often arises in connection with minor injuries; underlying weakness of the arterial wall (possibly only temporary) may be a predisposing factor. Acute unilateral pain is the main presenting symptom. In internal carotid dissection, the site of the pain is temporal in 46% of cases, and frontal in 19%; in vertebral artery dissection, it is nuchal and occipital in 80%. Pain and local findings, such as Horner syndrome, are generally present from the beginning, while stroke may arise only after a latency of hours to days. If the diagnosis is made early with MRI, CT, or ultrasound, and anticoagulation or antiplatelet drugs can help prevent a stroke, yet none of these methods can detect all cases. Recurrent dissection is rare, except in patients with connective tissue diseases such as Ehlers-Danlos syndrome or fibromuscular dysplasia. Spontaneous dissection of the great vessels of the neck must be differentiated from aortic dissection spreading to the supra-aortic vessels and from traumatic dissection due to blunt or penetrating vascular trauma. CONCLUSION Dissection of the cervical brain-supplying vessels is not always revealed by the imaging methods that are used to detect it. Stroke prevention thus depends on the physician's being aware of the symptoms and signs of this disease entity, so that early diagnosis can be followed by appropriate treatment.
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Affiliation(s)
- Christian Arning
- Praxis Neurologie und Neuro-Ultraschall, Hamburg,*Facharzt für Neurologie und Psychiatrie Moorhof 2d, D-22399 Hamburg, Germany
| | | | - Bernd Eckert
- Department of Neuroradiology, Asklepios Klinik Altona, Hamburg
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Peng J, Wu M, Doycheva DM, He Y, Huang Q, Chen W, Matei N, Ding J, Chen K, Xu N, Zhou Z. Establishment of Carotid Artery Dissection and MRI Findings in a Swine Model. Front Neurol 2021; 12:669276. [PMID: 34220678 PMCID: PMC8242238 DOI: 10.3389/fneur.2021.669276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/05/2021] [Indexed: 11/22/2022] Open
Abstract
Carotid artery dissection (CAD) is the leading cause of ischemic stroke in young patients; however, the etiology and pathophysiology of CAD remain largely unknown. In our study, two types of dissections (length × width: 1.5 cm × 1/3 circumference of intima, Group I, n = 6; or 1.5 cm × 2/3 circumference of intima, Group II, n = 6) were created between the media and intima. Ultrasound (within 2 h after dissection) showed a dissociated intima in the lumen and obstructed blood flow in the surgical area. Digital subtraction angiography (DSA, 72 h after dissection), magnetic resonance imaging (MRI, 72 h after dissection), and hematoxylin–eosin (H&E, 7 days after dissection) staining confirmed stenosis (33.67 ± 5.66%) in Group I and total occlusion in Group II. In 10 out of 12 swine, the CAD model was established using a detacher and balloon dilation, and morphological outcomes (stenosis or occlusion) after CAD were determined by the size of intimal incision.
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Affiliation(s)
- Jing Peng
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Min Wu
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Desislava Met Doycheva
- Departments of Physiology and Pharmacology, Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Yi He
- Department of Microsurgery, Chongqing Hengsheng Surgical Hospital, Chongqing, China
| | - Qiongzhen Huang
- Department of Interventional Therapy, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Nathanael Matei
- Departments of Physiology and Pharmacology, Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Jun Ding
- Department of Ultrasound, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Kangning Chen
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ningbo Xu
- Department of Interventional Therapy, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenhua Zhou
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
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4
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Lounsbury E, Dewar B, Davis A, Fergusson DA, Dowlatshahi D, Shamy M. Recurrence of cervical artery dissection: protocol for a systematic review. BMJ Open 2020; 10:e037124. [PMID: 32928855 PMCID: PMC7488837 DOI: 10.1136/bmjopen-2020-037124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cervical artery dissection, including carotid and vertebral artery dissection, is an important cause of stroke in the young. Risk of developing cervical artery dissection has been associated with physical activity in various forms and has been presumed to be related to minor trauma and mechanical stretching of the cervical arteries. This systematic review will aim to synthesise data on the risk of recurrent cervical artery dissection after an initial dissection. This information may be applied to further understand the natural history of this disease, and potentially to help direct evidence-based discussions on safe return to activity after dissection. METHODS AND ANALYSIS A broad search of multiple electronic databases (Medline, Embase, Cochrane Central Register of Controlled Trials and Web of Science) will be conducted to identify studies published as of 13 November 2019, examining all-comers with cervical artery dissection observed over time. Studies will be screened by two independent reviewers in a two-level process to determine eligibility for inclusion. Data will be pooled from eligible articles and the main outcome of recurrent cervical artery dissection at 5 years will be determined using quantitative analysis. ETHICS AND DISSEMINATION Ethics approval is not necessary as no primary data are being collected. The information will be disseminated in the form of a systematic review article which will be submitted to a peer-reviewed medical journal. PROSPERO REGISTRATION NUMBER CRD42020166105.
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Affiliation(s)
| | - Brian Dewar
- Neuroscience, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexandra Davis
- Library Services, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Michel Shamy
- Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Neuroscience, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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5
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Bernstein C, Wayne PM, Rist PM, Osypiuk K, Hernandez A, Kowalski M. Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series. Glob Adv Health Med 2019; 8:2164956119835778. [PMID: 30944771 PMCID: PMC6440032 DOI: 10.1177/2164956119835778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/31/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
This case series illustrates an integrated model of care for migraine that combines standard neurological care with chiropractic treatment. For each patient, we describe the rationale for referral, diagnosis by both the neurologist and chiropractor, the coordinated care plan, communication between the neurologist and chiropractor based on direct face-to-face "hallway" interaction, medical notes, team meetings, and clinical outcomes. Findings are evaluated within the broader context of the multicause nature of migraine and the impact of integrative chiropractic. Suggestions for future areas of research evaluating integrative approaches are discussed.
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Affiliation(s)
- Carolyn Bernstein
- Osher Clinical Center, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter M Wayne
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kamila Osypiuk
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Audrey Hernandez
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Matthew Kowalski
- Osher Clinical Center, Brigham and Women’s Hospital, Boston, Massachusetts
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Giannini N, Ulivi L, Maccarrone M, Montano V, Orlandi G, Ferrari E, Cravcenco C, Bonuccelli U, Mancuso M. Epidemiology and cerebrovascular events related to cervical and intracranial arteries dissection: the experience of the city of Pisa. Neurol Sci 2017; 38:1985-1991. [PMID: 28815313 DOI: 10.1007/s10072-017-3084-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/29/2017] [Indexed: 12/28/2022]
Abstract
Spontaneous dissection of cervical arteries (sCAD) is a major cause of ischemic stroke in young patients, with an incidence varying from 1.7 to 3/100,000/year for extracranial internal carotid artery (ICAD) and 1 to 1.9/100,000/year for extracranial vertebral artery (VAD). Reliable epidemiological data on stroke incidence related to sCAD are scarce in Italy. This study aims to evaluate the incidence, clinical features, and outcome of cerebrovascular events related to sCAD and spontaneous intracranial arteries dissections (sIAD) in the city of Pisa (Italy). We retrospectively analyzed consecutive patients admitted between December 1997 and June 2015 with a diagnosis of stroke, TIA, or Bernard-Horner syndrome due to acute cervical or intracranial artery dissection. Considering that our hospital collects presumptively all patients hospitalized with sCAD coming from the referral geographical area, data may provide a good approximation to real incidence of sCAD in our population. Clinical and radiological features, acute treatment and outcome were collected. Seventy-seven cases were included (mean age 48.1±10.4 years, range 23-77,72.7% males), 66 residents in the district of Pisa. Crude incidence rate of cerebrovascular events due to intra or extracranial dissection was 1.88/100,000/year. The incidence of ICAD was 0.80/100,000/year and 0.43/100,000/year for VAD. Stroke occurred in 76.6% of patients. VAD was more prone to cause ischemic stroke and present with cervical pain or focal signs (p < 0.01) than ICAD group, which had older age at onset. sIAD were more frequent in the posterior circle (p = 0.01) and more associated with ischemic lesions. A good outcome (mRS 0-2) was observed in 79% of patients. This is the first epidemiological attempt to investigate impact of sCAD and sIAD in Italy.
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Affiliation(s)
- N Giannini
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - L Ulivi
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - M Maccarrone
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - V Montano
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - G Orlandi
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - E Ferrari
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - C Cravcenco
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - U Bonuccelli
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - M Mancuso
- Clinical and Experimental Medicine Department, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
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7
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Smoot TW, Taha A, Tarlov N, Riebe B. Eagle syndrome: A case report of stylocarotid syndrome with internal carotid artery dissection. Interv Neuroradiol 2017; 23:433-436. [PMID: 28530160 DOI: 10.1177/1591019917706050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eagle syndrome is defined by an elongated styloid process or a calcified stylohyoid ligament that impinges on surrounding structures and causes a variety of symptoms. Classically, Eagle syndrome presents as neck, throat, or ear pain. The vascular variant, stylocarotid syndrome, can present as headache, transient ischemic attack, or stroke. Carotid artery dissection is a rare complication of stylocarotid syndrome. We report a case of stylocarotid syndrome in a 60-year-old man who presented with a right internal carotid artery (ICA) dissection and focal neurological deficits. Computed tomography with three-dimensional reformatting was used in the evaluation of his pathology. His dissecting right ICA was stented with subsequent symptom resolution. Improved recognition of the relationship between an elongated styloid or calcified stylohyoid ligament and symptomatology may lead to optimal etiology recognition and directed treatment.
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Affiliation(s)
- Travis W Smoot
- 1 University of Missouri, Columbia School of Medicine, University of Missouri Hospital, USA
| | - Ammar Taha
- 2 Department of Radiology, University of Missouri Hospital, USA
| | - Nicholas Tarlov
- 3 Department of Neurology, University of Missouri Hospital, USA
| | - Blake Riebe
- 2 Department of Radiology, University of Missouri Hospital, USA
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Kranenburg HA, Schmitt MA, Puentedura EJ, Luijckx GJ, van der Schans CP. Adverse events associated with the use of cervical spine manipulation or mobilization and patient characteristics: A systematic review. Musculoskelet Sci Pract 2017; 28:32-38. [PMID: 28171776 DOI: 10.1016/j.msksp.2017.01.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 01/19/2023]
Abstract
Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk for adverse events. It would be valuable if patients at risk could be identified by specific characteristics during the preliminary screening. Objective was to identify characteristics of 1) patients, 2) practitioners, 3) treatment process and 4) adverse events (AE) occurring after CSM or cervical mobilization. A systematic search was performed in PubMed, Embase, CINAHL, Web-of-science, AMED, and ICL (Index Chiropractic Literature) up to December 2014. Of the initial 1043 studies, 144 studies were included, containing 227 cases. 117 cases described male patients with a mean age of 45 (SD 12) and a mean age of 39 (SD 11) for females. Most patients were treated by chiropractors (66%). Manipulation was reported in 95% of the cases, and neck pain was the most frequent indication. Cervical arterial dissection (CAD) was reported in 57% (P = 0.21) of the cases and 45.8% had immediate onset symptoms. The overall distribution of gender for CAD is 55% (n = 71) for female and therefore opposite of the total AE. Patient characteristics were described poorly. No clear patient profile, related to the risk of AE after CSM, could be extracted. However, women seem more at risk for CAD. There seems to be under-reporting of cases. Further research should focus on a more uniform and complete registration of AE using standardized terminology.
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Affiliation(s)
- H A Kranenburg
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.
| | - M A Schmitt
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - E J Puentedura
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, Las Vegas, NV, USA
| | - G J Luijckx
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - C P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, The Netherlands
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Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 2016; 8:e498. [PMID: 27014532 PMCID: PMC4794386 DOI: 10.7759/cureus.498] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/14/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD. METHODS Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria. RESULTS Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was "very low." CONCLUSIONS The quality of the published literature on the relationship between chiropractic manipulation and CAD is very low. Our analysis shows a small association between chiropractic neck manipulation and cervical artery dissection. This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.
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Affiliation(s)
| | - Emily P Sieg
- Department of Neurosurgery, Penn State Hershey Medical Center
| | - Omar Zalatimo
- Department of Neurosurgery, Penn State Hershey Medical Center
| | | | - Michael Glantz
- Department of Neurosurgery, Penn State Hershey Medical Center
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Mikkelsen R, Dalby RB, Hjort N, Simonsen CZ, Karabegovic S. Endovascular Treatment of Basilar Artery Thrombosis Secondary to Bilateral Vertebral Artery Dissection with Symptom Onset Following Cervical Spine Manipulation Therapy. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:868-71. [PMID: 26647210 PMCID: PMC4678923 DOI: 10.12659/ajcr.895273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patient: Female, 37 Final Diagnosis: Vertebral artery dissection Symptoms: Neck pain and focal neurological deficits Medication: No previous Clinical Procedure: Endovascular thrombectomy Specialty: Neurology
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Affiliation(s)
- Ronni Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Beese Dalby
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Hjort
- Danish Stroke Center, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sanja Karabegovic
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
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Kim HK, Lee SH, Kim JH, Lee KY. Acute Cerebellar Infarction Caused by Superior Cerebellar Artery Dissection. JOURNAL OF NEUROCRITICAL CARE 2014. [DOI: 10.18700/jnc.2014.7.2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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12
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Correa E, Martinez B. Traumatic dissection of the internal carotid artery: simultaneous infarct of optic nerve and brain. Clin Case Rep 2014; 2:51-6. [PMID: 25356244 PMCID: PMC4184630 DOI: 10.1002/ccr3.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/05/2014] [Accepted: 01/25/2014] [Indexed: 11/10/2022] Open
Abstract
KEY CLINICAL MESSAGE Traumatic intracranial internal carotid artery dissection is a rare but significant cause of stroke in patients in their forties, leading to high morbidity and mortality. Simultaneous ischemic stroke and optic nerve infarction can occur. Clinical suspicion of dissection is determining in the acute management.
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Affiliation(s)
- Edgar Correa
- Department of Neurology, Andrade Marín Hospital, San Francisco of Quito UniversityQuito, Ecuador
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13
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Muthusami P, Kesavadas C, Sylaja PN, Thomas B, Harsha KJ, Kapilamoorthy TR. Implicating the long styloid process in cervical carotid artery dissection. Neuroradiology 2013; 55:861-7. [PMID: 23579551 DOI: 10.1007/s00234-013-1186-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/02/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To look for the presence and strength of association of cervical carotid artery dissection (CCAD) with a long styloid process. METHODS This case-control analysis included 35 patients with 37 affected carotid arteries. CT angiograms of these patients were analyzed by two raters blinded to clinical and radiological diagnosis. Parameters assessed were styloid process length, its proximity to the cervical internal carotid artery, and its medial and anterior angulations. The same parameters were assessed in 70 CT angiograms in age and sex matched controls. RESULTS Interrater correlations were 0.87, 0.40, 0.71, and 0.79 for styloid process length, contact distance, medial angulation, and anterior angulation, respectively. The mean styloid process length on the affected side was significantly more than on the contralateral side (37.8 vs. 34.6 mm, p = 0.006). There were also significant length and contact distance differences between the styloid processes ipsilateral to dissection and ipsilateral styloid processes of controls (38.9 vs. 36.2 mm, p = 0.05 and 3.1 vs. 5.0 mm, p = 0.05, respectively). There were increasing odds ratios (OR) for dissection with increasing styloid process length, with OR of 4.36 (95% CI = 1.04 to 18.4, p = 0.04) for length more than 50 mm. ORs for dissection increased with decreasing contact distance, with OR for distances less than 5 mm being 7.58 (95% CI = 0.93 to 62.1, p = 0.06). There was no significant association of CCAD with angulation of the styloid process. CONCLUSION Length and contact distance of the styloid process are risk factors for CCAD, suggesting mechanical impingement.
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Affiliation(s)
- Prakash Muthusami
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India 695011.
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