Podcast
Questions and Answers
What are common early presenting features of cervical arterial dissection (CAD)?
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?
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?
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)?
What is a significant consideration in assessing patients for vertebrobasilar insufficiency (VBI)?
Which statement about neck movement and position is accurate regarding CAD?
Which statement about neck movement and position is accurate regarding CAD?
Which demographic is more likely to present with cervical arterial dissection?
Which demographic is more likely to present with cervical arterial dissection?
What symptom is NOT included as one of the 5 D's associated with VBI?
What symptom is NOT included as one of the 5 D's associated with VBI?
During VBI testing, what should the clinician observe for when performing sustained end range rotation?
During VBI testing, what should the clinician observe for when performing sustained end range rotation?
What action should be taken if symptoms worsen during VBI testing?
What action should be taken if symptoms worsen during VBI testing?
In addition to observing for nystagmus, what critical aspect is assessed during VBI testing?
In addition to observing for nystagmus, what critical aspect is assessed during VBI testing?
Which of the following indicates a positive VBI test?
Which of the following indicates a positive VBI test?
What precaution should be taken when conducting VBI testing?
What precaution should be taken when conducting VBI testing?
Which test is the minimum recommended before proceeding to ERRT or HVT?
Which test is the minimum recommended before proceeding to ERRT or HVT?
In the context of VBI testing, what additional testing is prompted by patient history?
In the context of VBI testing, what additional testing is prompted by patient history?
What is the primary classification system for lower cervical spine fractures based on the provided information?
What is the primary classification system for lower cervical spine fractures based on the provided information?
Which type of fracture is characterized by compression in the AO SPINE classification?
Which type of fracture is characterized by compression in the AO SPINE classification?
Which of the following is not a typical symptom of craniovertebral instability?
Which of the following is not a typical symptom of craniovertebral instability?
What does a Hangman's fracture specifically involve?
What does a Hangman's fracture specifically involve?
Which diagnostic procedure is necessary in the case of severe signs and symptoms with acute trauma related to craniovertebral instability?
Which diagnostic procedure is necessary in the case of severe signs and symptoms with acute trauma related to craniovertebral instability?
Which of the following symptoms is indicative of cord compromise in craniovertebral instability?
Which of the following symptoms is indicative of cord compromise in craniovertebral instability?
Which type of AO SPINE fracture indicates an anterior distraction due to hyperextension?
Which type of AO SPINE fracture indicates an anterior distraction due to hyperextension?
What symptom might suggest the presence of vascular issues related to craniovertebral instability?
What symptom might suggest the presence of vascular issues related to craniovertebral instability?
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.
