mean age of pts. affected by VAS assosiated w manipulation
47.9 years old
females may be more affected
where do most cases of aditional arterial thrombosis occur in VAS patients
Carotid artery in elderly
mechanisms of vascular insuffiency
- vert artery insufficieny _ due to occlusion of 1 or both
- Arterial wall damage (intimal tear) or (intimal tear with embolic formation)
- Vessel wall dissection- redduces bf and can produce clots
- perivascular bleeding
What are the two onset times and what causes it
- vasoconstriction/ Embolism- Results in immediate onset of symptoms
- Thrombosis- result in onset in hours to days
3 sites of vertebral artery compression
- bw C0-1 (contralat to rot)
- bw C1-2
- Bw C2-3 (ipsilat rot)
4 major risk factors for VAS
- hypertension
- Smoking
- Oral contraceptives
- Migranes
Fibromuscular dysplasia account for what % of Vas cases
25%
What are the 5 d’s and 3 N’s
diplopia (double vis) drop attack (fainting) Dizziness Dysarthria (slurred speach) Dysphagia (swallowing difficulties)
Ataxia (uncoordiated mvmt)
Numbness
Nystagmus (invol eye mvmts)
Nausea
How is traumatic thrombosis of a vertebral artery diagnosed
Using MRA
What does PICA blockages result in
associated with numbness on 1 side of the body
What is pontine artery blockage associated with
Associated with paralysis
3 main causes of vertebrobasilar artery dissection (most to least)
- Iatrogenic
- Neck manip
- Trauma
