Risk Factors And Clinical Presentation Of Cervical Arterial Dissection: Preliminary Results Of A Prospective Case Control Study
Authors: Lucy C. Thomas, PhD, MMedSc (Physiotherapy)1,5, Darren A. Rivett, PhD, MAppSc (ManipPhty)2, John R. Attia, MD, PhD3, Christopher Levi, BMedSc, MBBS, FRACP4
Published: Journal of Orthopaedic & Sports Physical Therapy, Ahead of Print Pages: 1-27 doi:10.2519/jospt.2015.5877
Study Design
Cross-sectional case-control study.
Objectives
To identify risk factors and clinical presentation of individuals with cervical arterial dissection.
Background
Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is considered to involve pre-existing arterial susceptibility and a precipitating event such as minor trauma. Identification of individuals at risk or early recognition of a dissection in progress could help expedite medical intervention and avoid inappropriate treatment.
Methods
Participants were individuals 55 years of age or less from the Hunter region of New South Wales, Australia with radiologically confirmed vertebral or internal carotid artery dissection and an age and gender matched comparison group. Participants were interviewed about risk factors, preceding events, and clinical features of their stroke. Physical examination of joint mobility and soft tissue compliance was undertaken.
Results
Twenty-four participants with cervical arterial dissection and 21 matched comparisons with ischaemic stroke but not dissection entered the study. Seventeen (71%) of the 24 participants with dissection reported a recent history of minor mechanical neck trauma or strain, with 4 of these 17 reporting being recently treated with neck manipulative therapy. Cardiovascular risk factors were uncommon with the exception of diagnosed migraine. Among the participants with dissection, 67% reported transient ischaemic features in the preceding month to their admission for dissection.
Conclusion
Recent minor mechanical trauma or strain to the head or neck appears to be associated with cervical arterial dissection. General cardiovascular risk factors with the exception of migraine were not important risk factors for dissection in this cohort. Preceding transient neurological symptoms appear to occur commonly and may assist in identification of this serious pathology.
Level of Evidence
Prognosis, level 4. J Orthop Sports Phys Ther, Epub 21 May 2015. doi:10.2519/jospt.2015.5877