Headache or facial or neck pain attributed to
arterial dissection (ICHD-6.5.1)
Cervical Spine Adjusting and the
Vertebral Artery
Arterial dissection
Unveiling the Risks
• Head Position
– Dental procedures
– Ceiling Painting
• Sports Activities
– Wrestling
– Judo
– Treadmill running
• Accidents
– Motor vehicle accidents
– Falls
– Airbag or seatbelt trauma
• Neck Trauma
– Cervical manipulation
– Abuse
– Incredibly, even sea wave
induced trauma
– Hand-held massager
• Leisure Activities
– Roller coasters
– Yoga
• Infection
– Narrowing of blood vessel
– Bouts of violent coughing
These factors can cause an arterial dissection which
result in a secondary stroke
About Stroke and dissection..
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3,000 VADs per year (700,000/yr in USA).
1 of every 233 strokes is related to a VAD.
75% of VAD related strokes make a good recovery.
5% of VAD related strokes result in death.
• 13% of stroke and under-diagnosed (CSC).
• Incidence of 2.5~3/100,000 (carotid), and
1~1.5/100,000 (vertebral)
(CSC=Canadian Stroke Consortium)
Genetic factors?
• Ehlers-Danlos syndrome.(rubber man syndrome)
• Fibromuscular dysplasia.
• Ultrastructural connective tissue abnormality.
• Homocystinaemia.
• Marfan’s syndrome.
• Cystic medial necrosis.
• Alpha-1-antitrypsin deficiency.
Two risks is relevant to dissection: trauma+ CTD (CSC)
Arterial Dissection
• Occurs when there is
breakdown in the vessel
wall of the artery causing
blood to flow into the
tissue layers instead of
into the lamina and clot
formation.
(Norris et al, 2000)
• Typically, the subsequent
stroke is secondary to the
dissection.
Subintimal vs. Subadventitial
Vessel lumen
Aneurysm
Types of Arterial Dissection
2 specific types
– Carotid Artery Dissection (CAD)
– Vertebral Artery Dissection (VAD)
Normal
Dissected
Carotid artery dissection (CAD)
• CAD are 3-5 times more prevalent than VAD.
• Presenting signs and symptoms include:
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Unilateral headache.
Local pain.
Ipsilateral Horner’s syndrome.
Dysarthria and Dysphagia.
Memory impairments.
Hemiparesis.
Visual impairment involving one field of vision.
(retinal occlusion may be a heralding symptom of dissection in some
cases)
(Campellone et al, 2004)
CAD
• Classic triad:
=Unilateral headache.
=Ipsilateral partial Horner’s syndrome.
=Contralateral hemispheric findings--aphasia, neglect, visual disturbance or
hemiparesis.
• Diagnosis is via angiography
(CTA,MRA).