CSF Flow Adjacent to a Stenotic Vertebral Segment and Vertebral Artery Dissection: Warning Signals that Precede Stroke
This edition focuses on a couple recent articles that discuss CSF Flow Adjacent to a Stenotic Vertebral Segment and Vertebral Artery Dissection: Warning Signals that Precede Stroke. As chiropractors, and particularly SOT doctors, become more involved in the treatment of disc hernation, canal stenosis, as well as cranial related conditions of vertigo, facial paralysis, and headaches these two articles will be of assistance.
1. Cerebrospinal Fluid Flow in the Cervical Spinal Canal in Patients with Chronic Neck Pain:
In this study of patients with chronic neck pain an MR images and CSF velocity was taken of the cervical spine. The focus of the measurements were to the stenotic segment and to the C2 (axis) level. They determined the stenosis by relating the size of the spinal cord to the dural sac. The study noted that at the stenotic segment there appeared no alteration of CSF flow, but caudal to the stenotic segment there was an increase in CSF flow in the anterior CSF space. (See Abstract Below)
2. Vertebral Artery Dissection: Warning Symptoms, Clinical Features and Prognosis in 26 Patients
In this retrospective hospital study of 26 patients with vertebral artery dissection, it was determined that “sporting activity and chiropractic manipulations were the most common (15% and 11% respectively)” causes. Since chiropractors proficient with SOT, AK and various cranial procedures see patients with differing conditions, it is important to be aware of important warning signs that may precede the onset of a st
CONCLUSION: Spinal stenosis does not alter the cord or CSF velocities at the C2 level, but increases the velocity of CSF in the anterior CSF space below the stenotic segment when the stenosis is assessed by cord and dural sac area measurements.
Vertebral Artery Dissection: Warning Symptoms, Clinical Features and Prognosis in 26 Patients * Journal: Can J Neurol Sci 2000 Nov;27(4):292-6 * Authors: Saeed AB, Shuaib A, Al-Sulaiti G, Emery D * Host: Department of Medicine, University of Alberta, Canada. * PMID: 11097518
roke by several days. Patients who present with findings of headache and/or neck pain followed by vertigo or unilateral facial paresthesia should be evaluated and treated carefully, since these are warning signs may precede the onset of a stroke by several days. Vertebral dissection affects mainly middle age persons and involves both sexes equally. (See Abstract Below)
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Cerebrospinal Fluid Flow in the Cervical Spinal Canal in Patients with Chronic Neck Pain * Journal: Acta Radiol 2000 Nov;41(6):578-83 * Authors: Parkkola RK; Rytokoski UM; Komu MES; Thomsen C * Host: Department of Diagnostic Radiology, University Hospital of Turku, Finland.
PURPOSE: To measure the cerebrospinal fluid (CSF) velocity in the cervical spinal canal both above and below a stenotic segment in patients with cervical spinal stenosis. The cord velocity was also measured at the level of C2.
MATERIAL AND METHODS: Thirteen patients with chronic neck pain were examined with MR imaging. The degree of cervical spinal stenosis was assessed and measured on MR images and CSF velocity in the cervical spinal canal was measured using the phase MR flow quantification method at the level of C2 and below the stenotic segment. The cord motion was measured at the level of C2.
RESULTS: The peak velocities of CSF in front of the cord at the level of C2 were, on average, a little higher than behind the cord, but the interindividual variation was high. The caudal or rostral velocities of CSF above and below the stenotic segment could be measured in most cases and they were not dependent on the degree of stenosis when assessed visually. When the stenosis was assessed by relating the cord area to the dural sac area, a statistical correlation between narrow spinal canal and high velocities in the anterior CSF space below the stenotic segment was found.
BACKGROUND AND OBJECTIVES: Internal carotid artery dissection has been extensively studied and well-described. Although there has been a recent increase in the number of reported cases of vertebral artery (VA) dissection, the clinical variety of presentation and the early warning symptoms have not been well-described before. Our objectives in this study include: (1) To determine the early symptoms and warning signs which may help the clinician in the early identification and treatment of patients with VA dissection. (2) To explore the variety of clinical presentation of VA dissection and its relation to prognosis.
DESIGN AND SETTING: Retrospective analysis of hospital records in a tertiary academic centre for the period 1989-1999.
RESULTS: Twenty-six patients were identified (13 men and 13 women). The mean age was 48. Possible precipitating factors were identified in 14 patients (53%). Sporting activity and chiropractic manipulations were the most common (15% and 11% respectively). Headache and/or neck pain was the prominent feature in 88% of patients and was a warning sign in 53%, preceding onset of stroke by up to 14 days. The most common clinical features included vertigo (57%), unilateral facial paresthesia (46%), cerebellar signs (33%), lateral medullary signs (26%) and visual field defects (15%). Bilateral VA dissection presented in six patients (24%). The most common region of dissection was the C1-C2 level (16 arteries, 51%). Intracranial VA dissection was found in eight arteries (25%). The majority of patients (83%) had favorable outcome. Poor prognosis was associated with (1) bilateral dissection; (2) intracranial VA dissection accompanied by subarachnoid hemorrhage. Only two patients reported stroke recurrence.
CONCLUSIONS: Our findings show that VA dissection affects mainly middle age persons and involves both sexes equally. Headache and/or neck pain followed by vertigo or unilateral facial paresthesia is an important warning sign that may precede onset of stroke by several days. Although the majority of patients will have excellent prognosis, this was less likely in patients presenting with subarachnoid hemorrhage or bilateral VA dissection. Recurrence rate was low.