Cervical Arterial Dissection Overview

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Questions and Answers

What are common early presenting features of cervical arterial dissection (CAD)?

Chronic low back pain

Acute onset neck pain and/or headache (correct)

Persistent shoulder discomfort

Visual disturbances

Which of the following is NOT considered a risk factor for cervical arterial dissection?

Age over 65 (correct)

Minor trauma

Genetic factors

Migraine

Which potential cause is associated with atherosclerosis in the cervical region?

Cervical radiculopathy

Osteophyte formation

Cervical arterial dissection (correct)

Herniated disc

What is a significant consideration in assessing patients for vertebrobasilar insufficiency (VBI)?

Eliciting upper quadrant dysfunction symptoms Signup and view all the answers

Which statement about neck movement and position is accurate regarding CAD?

Neck movements can provoke symptoms of CAD. Signup and view all the answers

Which demographic is more likely to present with cervical arterial dissection?

Younger populations under 65 years Signup and view all the answers

What symptom is NOT included as one of the 5 D's associated with VBI?

Hypotension Signup and view all the answers

During VBI testing, what should the clinician observe for when performing sustained end range rotation?

Nystagmus Signup and view all the answers

What action should be taken if symptoms worsen during VBI testing?

Cease testing and refer the patient Signup and view all the answers

In addition to observing for nystagmus, what critical aspect is assessed during VBI testing?

Symptom reproduction Signup and view all the answers

Which of the following indicates a positive VBI test?

Nystagmus that does not settle within a few seconds Signup and view all the answers

What precaution should be taken when conducting VBI testing?

Cease testing if symptoms worsen or do not settle Signup and view all the answers

Which test is the minimum recommended before proceeding to ERRT or HVT?

Sustained end range rotation Signup and view all the answers

In the context of VBI testing, what additional testing is prompted by patient history?

Cervical Extension with or without combined rotation Signup and view all the answers

What is the primary classification system for lower cervical spine fractures based on the provided information?

AO SPINE classification Signup and view all the answers

Which type of fracture is characterized by compression in the AO SPINE classification?

Type A fractures Signup and view all the answers

Which of the following is not a typical symptom of craniovertebral instability?

Vision impairment Signup and view all the answers

What does a Hangman's fracture specifically involve?

Fracture of both pedicles or pars interarticularis of the axis vertebra Signup and view all the answers

Which diagnostic procedure is necessary in the case of severe signs and symptoms with acute trauma related to craniovertebral instability?

Urgent referral for diagnostic imaging Signup and view all the answers

Which of the following symptoms is indicative of cord compromise in craniovertebral instability?

Difficulty walking Signup and view all the answers

Which type of AO SPINE fracture indicates an anterior distraction due to hyperextension?

Type B3 Signup and view all the answers

What symptom might suggest the presence of vascular issues related to craniovertebral instability?

Feeling of instability Signup and view all the answers

Study Notes

Early Presenting Features

Acute neck pain and headache may mimic musculoskeletal conditions.
Important risk factors include minor trauma, infections, genetic predisposition, and potentially migraines.

Cervical Arterial Dissection (CAD)

CAD often presents in those under 65 but can occur in younger populations.
Commonly associated with chronic neck pain and stiffness.
Symptoms related to neck movement and positions.
Potential causes include atherosclerosis, spondylosis (osteophyte formation), trauma, and occlusion during neck movements.

Vertebrobasilar Insufficiency (VBI) Questioning

In patients with upper quadrant dysfunction, all must be screened for VBI symptoms.
Specific focus on the "5 D's" (Dizziness, Diplopia, Dysarthria, Dysphagia, Drop attacks) and "3 N's" (Nausea, Numbness, Nystagmus).

VBI Testing

VBI positional tests used when symptoms are ambiguous; cease if symptoms worsen.
Minimum tests include sustained end range rotation to evaluate symptoms.
Positive tests observed include dizziness and nystagmus that doesn't resolve quickly.

Odontoid (Dens) Fracture

Classified using the Anderson and D’Alonzo system.
Important for understanding fracture implications and management.

Fractures of the Cervical Spine

Hangman's fracture refers specifically to a fracture of the C2 vertebra's pedicles.
The AO Spine Classification categorizes lower cervical fractures into three types:
- Type A (Compression): A1 (Impaction), A2 (Split), A3 (Burst)
- Type B (Distraction): B1 (Posterior injury), B2 (Combination), B3 (Anterior distraction)
- Type C (Rotation): C1 (Unilateral facet fracture-dislocation), C2 (Unilateral facet dislocation), C3 (Separation with combination fractures)

Craniovertebral Instability Presentation

Common symptoms include neck pain, wry neck posture, headaches, and signs of myelopathy, such as difficulty walking and loss of coordination.
Vascular symptoms and a feeling of instability may also be present.

Craniovertebral Instability Diagnosis

Severe signs or acute trauma necessitate urgent imaging referral.
Alar ligament tests are crucial for diagnosis and assessment of instability.

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Description

This quiz covers the early presenting features and risk factors associated with Cervical Arterial Dissection (CAD). It highlights the importance of recognising clinical symptoms that may resemble musculoskeletal presentations, such as acute neck pain and headache. Understanding these factors is crucial for safe manual therapy practice in the cervical spine.