Development of a diagnostic support tool for predicting cervical arterial dissection in primary care.

Objectives: Cervical arterial dissection (CAD) is an important cause of stroke in young people which may be missed because early features may mimic migraine or a musculoskeletal presentation. The study aimed to develop a diagnostic support tool for early identification of CAD.

Design: Retrospective observational study.

Sub-occipital muscle pressure pain thresholds correlate to direction of symptomatic active comfortable sustained neck rotation testing in post-concussive headache: a retrospective observational cross-sectional study.

Objectives: To compare sub-occipital muscle pressure sub pain thresholds (PPTs) in individuals with persistent-post-traumatic-headache (PPTH) in relation to the presence or not of cranial nerve and/or autonomic symptoms reported during sustained neck rotation (SNR).

Background: Previously 81% of military service members with PPTH demonstrated symptoms with SNR up to 60 seconds. Of these, 54% reported symptoms in one (Uni-Symp) and 46% in both directions of rotation (Bi-Symp).

Reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization may help identify cervicogenic headaches: a case-control study.

Background: The relative value of clinical tests toward identifying cervicogenic headache (CGH) remains under investigated. Whilst certain physical examination findings have been associated with CGH, consensus on which findings provide the strongest association remains elusive.

Objectives: To determine which cervical musculoskeletal assessment procedures used in CGH are positively associated with CGH.

Possible autonomic or cranial nerve symptoms triggered during sustained neck rotation in persistent headache post-concussion: a retrospective observational cross-sectional study.

Objectives: To examine and categorize symptoms occurring within 60 s of vertebrobasilar-insufficiency (VBI) testing (left- and right-neck rotation) in individuals with persistent post-traumatic headache.

Background: As part of routine clinical cervical screening in our patients, we found extended VBI testing often triggered additional symptoms. Therefore, we aimed to document the prevalence and precise symptoms occurring during each movement direction of this test and determine any demographic or baseline signs or symptoms associated with a positive test.

Improving the recognition of cervical arterial dissection in clinical practice: investigation of a five criteria diagnostic support tool.

Background: Cervical arterial dissection (CeAD) is a serious condition that can mimic a musculoskeletal condition. A diagnostic tool using five key criteria could help prompt early medical referral, but these criteria may occur in healthy people or benign neck pain/headache.

Objective: To determine the frequency of CeAD criteria in healthy individuals and those with neck pain/headache, and identify refinements needed to improve specificity.

A Systematic Review of the Diagnostic Criteria Used to Select Participants in Randomised Controlled Trials of Interventions Used to Treat Cervicogenic Headache.

Objective: The aim of this study was to determine the diagnostic criteria used in randomized controlled trials to define trial participants as having cervicogenic headache (CeH).

Background: While animal and human studies suggest a biological basis for "cervicogenic" headaches the diagnostic criteria necessary to evidence CeH are debated.

Methods: A systematic review was undertaken guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Changes in internal carotid and vertebral arterial wall stiffness with head movement can be detected with shear wave elastography.

: Safe practice is important for patients with neck pain, with the potential for injury to cervical arteries. Cervical manipulation or end range techniques/positions may place considerable strain on the arteries. Altered integrity of the arterial wall may render them more susceptible to minor trauma, particularly in the upper cervical region.

Seasonal variation in cervical artery dissection in the Hunter New England region, New South Wales, Australia: A retrospective cohort study.

Background: Cervical artery dissection (CAD) is a leading cause of ischemic stroke among middle aged adults, yet the aetiology remains poorly understood. There are reports from colder northern hemisphere sites of a seasonal pattern in the incidence of CAD. Seasonality may suggest some transient putative pro-inflammatory mechanism but it is unknown whether this also exists in temperate climates.

Seasonal Variation in Spontaneous Cervical Artery Dissection: Comparing between UK and Australian Sites.

Background: Cervical artery dissection (CAD) is a leading cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of seasonal variation in CAD incidence have been suggested but may reflect extreme climatic conditions. Seasonal variation may implicate more transient seasonal causes such as proinflammatory or hypercoagulable states.

Cervical arterial dissection: An overview and implications for manipulative therapy practice.

Introduction: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to minor trauma or infection. The incidence is difficult to determine accurately as not all CAD progress to stroke.

Risk Factors and Clinical Presentation of Cervical Arterial Dissection: Preliminary Results of a Prospective Case-Control Study.

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 effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: A sub analysis of an MRI study.

Introduction: Cervical spine manual therapy has been associated with a small risk of serious adverse neurovascular events, particularly to the vertebral arteries. Sustained end-range rotation is recommended clinically as a pre-manipulative screening tool; however ultrasound studies have yielded conflicting results about the effect of rotation on blood flow in the vertebral arteries. There has been little research on internal carotid arterial flow or utilising the reference standard of angiography.

Effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and cerebral inflow.

Background: Manual therapy of the cervical spine has occasionally been associated with serious adverse events involving compromise of the craniocervical arteries. Ultrasound studies have shown certain neck positions can alter craniocervical arterial blood flow velocities; however, findings are conflicting. Knowledge about the effects of neck position on blood flow may assist clinicians in avoiding potentially hazardous practices.

Risk factors, radiological features, and infarct topography of craniocervical arterial dissection.

Background: Craniocervical arterial dissection is a common cause of ischemic stroke in the young to middle-aged population. There have been a number of previous studies where radiological features have been described but few with detailed mapping of infarct topography and none where these features have been related to the reported risk factors.

Aims: The aims of this study were to describe the radiological characteristics of dissection patients ≤55 years and relate these to reported risk factors.

Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study.

Background: Craniocervical arterial dissection is a major cause of ischaemic stroke in young adults. The pathogenesis is not fully understood but is thought to be related to a combination of an intrinsic weakness in the arterial wall and an external trigger. Intrinsic susceptibility is thought to be a generalised arteriopathy, vascular anomaly or genetic predisposition.

Risk factors and clinical features of craniocervical arterial dissection.

Craniocervical arterial dissection is one of the most common causes of ischaemic stroke in young people and is occasionally associated with neck manipulation. Identification of individuals at risk will guide risk management. Early recognition of dissection in progress will expedite medical intervention.

Validity of the Doppler velocimeter in examination of vertebral artery blood flow and its use in pre-manipulative screening of the neck.

Pre-existing compromise of one or both vertebral arteries is considered a contraindication to neck manipulation. Current pre-manipulative screening tests may not adequately identify individuals with such compromise. It has been proposed that using a continuous wave ultrasound device (Doppler velocimeter) may assist in identifying patients presenting with flow abnormalities.

Pre-manipulative testing and the use of the velocimeter.

Manipulation of the cervical spine remains a common intervention for neck pain and dysfunction, despite the well-documented associated risk of vertebrobasilar stroke. The currently advocated pre-manipulative risk assessment protocols include the use of provocative positional tests to challenge the integrity of the vascular supply to the brain. This paper critically evaluates the validity of these pre-manipulative provocative tests in the light of ultrasonographic blood flow studies of the vertebral arteries.