Spontaneous Vertebral Artery Dissection Presenting with.
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.
Spontaneous cervical artery dissection is caused by a hematoma in the arterial wall. Recent research revealed that the most likely pathophysiological key mechanism is rupture of a vas vasorum resulting in a bleeding into the medio-adventitial borderzone .The expansion of the hematoma into the arterial lumen can secondarily lead to a rupture of the tunica intima with a high risk of thrombus.
Vertebral artery dissection, like arterial dissection elsewhere, is a result of blood entering the media through a tear in the intima. It is potentially lethal and can be difficult to diagnose clinically and radiologically. Epidemiology Vertebral artery dissections have an incidence of 1-5 per.
Vertebral artery dissecting aneurysm is an important diagnosis because of the high association with ischemic stroke, especially in the young adult population (2). It represents about 25% of cases in the age ranges of 18 to 45 yr, second only to cardiac embolism (3,7).
Incidence of vertebral artery injury (VAI) 0.5% of all trauma patients 70% of VAI in blunt trauma has associated cervical fracture; 33%-39% of all cervical spine fractures; 0.3% anterior cervical spine surgery; 4.1-8.2% posterior cervical spine surgery (C1-2 transarticular screws).
Arterial dissection occurs when an intimal tear allows blood to enter the arterial wall, potentially compromising the lumen and reducing blood flow. Carotid and vertebral artery dissections typically occur after major trauma, although they also can arise spontaneously or after trivial injury.
Intramural hematoma dissection is the most common type of extracranial vertebral artery dissection. Over other angiographic examinations US has a big diagnostic advantage for its direct view, accuracy, and low cost. 1 Introduction Vertebral artery dissection (VAD) is not rare in the young adult population.