1/6. Extracranial vertebral artery dissection causing cervical root lesion.The authors report an unusual manifestation of extracranial vertebral artery dissection (VAD), presenting with a predominantly motor radicular manifestation. Cervical magnetic resonance imaging (MRI) revealed the intramural hematoma in the dissected vessel wall, compressing mainly the segmental motor root and, to a lesser degree, the sensory ganglion. In the digital subtraction angiography (DSA), a circumscribed narrowing of the incriminated vessel was demonstrated. color-coded Duplex imaging (CDDI) revealed complete recanalization after a few days of anticoagulation treatment. Complete neurologic recovery was seen after 3 months. Considering the MRI data, the likely pathogenetic mechanism was compression of the nerve root by the intramural hematoma. The synopsis with similar cases in the literature points to the characteristic features, i.e., the association of neck pain with radicular motor deficit and the absence of degenerative disk disease. The respective syndrome should raise the suspicion of vertebral artery dissection, especially in young individuals.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/6. Is cervical spinal manipulation dangerous?OBJECTIVE: Concern about cerebrovascular accidents after cervical manipulation is common. We report a case of cerebrovascular infarction without sequelae. CLINICAL FEATURES: A 39-year-old man with nonspecific neck pain was treated by his general practitioner with cervical manipulation. INTERVENTION AND OUTCOME: This immediately elicited severe headache and neurologic symptoms that disappeared completely within 3 months despite permanent signs of a complete left-sided cerebellar infarction on computed tomography and magnetic resonance imaging. At 7-year follow-up the patient was fully employed, and repeated magnetic resonance imaging still showed infarction of the left cerebellar hemisphere. However, the patient remained completely free of neurologic symptoms, and color duplex ultrasonography showed normal cervical vessels, including patent vertebral arteries. CONCLUSION: It appears that the risk of cerebrovascular accidents after cervical manipulation is low, considering the enormous number of treatments given each year, and very much lower than the risk of serious complications associated with generally accepted surgery. Provided there is a solid indication for cervical manipulation, we believe that the risk involved is acceptably low and that the fear of serious complications is greatly exaggerated.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/6. Severe coronary artery disease presenting with a chief complaint of cervical pain.We present the case of a 49-yr-old man with cervical pain of 14 wk of duration. physical examination and magnetic resonance imaging of the cervical spine demonstrated no neurologic abnormality or corroborative pathology. cardiac catheterization demonstrated advanced multivessel disease. The patient underwent successful coronary bypass grafting and was symptom free 12 mo later. spine practitioners are often consulted by the medical community to determine if a patient's limb or chest complaints might be caused by a spinal pain generator. This atypical case reminds us of the overlap between cardiac and cervical symptom referral. A patient with critical cardiac ischemia can present with predominant cervical complaints.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/6. Spinal epidural epitheloid hemangioma--case report and review of the literature.Epitheloid hemangiomas are benign vascular lesions composed of epitheloid endothelial-cell-lined channels. We report an unusual case of a purely extradural non-osseous spinal epitheloid hemangioma presenting with quadriparesis. A 5-year-old boy presented with neck pain and quadriparesis following a trivial fall. MRI revealed a mixed intensity extradural lesion compressing the cervico-thoracic spinal cord posteriorly. At surgery the lesion consisted of vascular granulation tissue admixed with blood clots without abnormal vessels. Bone was normal. Histopathology revealed it to be an epitheloid hemangioma. The case and relevant literature is reviewed.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/6. Clinical diagnosis of vertebrobasilar insufficiency: resident's case problem.STUDY DESIGN: Resident's case problem. BACKGROUND: vertigo and visual disturbances are common symptoms associated with vertebrobasilar insufficiency (VBI), but the physical examination procedures to verify the existence of VBI have not been validated in the literature. The objective of this resident's case problem is to demonstrate how a patient's complaint of vertigo and visual disturbances, combined with positive clinical examination findings, can be a potential medical screening tool for VBI. diagnosis: The patient in this report was initially referred to physical therapy for neck pain. However, the patient's chief concerns identified during the history were (1) vertigo, (2) visual disturbances, (3) headache, and (4) right shoulder region pain. Clinical VBI tests were performed, whereby the patient's vertigo and visual disturbances were reproduced with cervical spine extension. The patient was sent back to the referring physician to be evaluated for possible VBI. diagnostic imaging tests were ordered. Carotid ultrasound revealed 80% to 90% stenosis in the proximal left internal carotid artery, and magnetic resonance angiography of the extracerebral vessels showed greater than 90% stenosis of the left internal carotid artery. DISCUSSION: VBI may be present in patients with subjective reports of vertigo and visual disturbances that are reproduced with VBI physical examination procedures.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/6. MRI and ultrasonographic imaging of a patient with carotidynia.A patient presented with a painful, pulsating nodosity with marked tenderness on the right side of her neck. Cervical magnetic resonance imaging (MRI) exhibited pathological signal changes in the perivascular tissue of the carotid bifurcation area and around the external carotid artery. Similarly, Doppler sonography revealed an echo-poor wall change with outward bulging and slight narrowing of the affected vessel lumen. The clinical symptoms and our findings led to the diagnosis of carotidynia. We proposed that cervical MRI and Doppler sonography could be used for diagnosing carotidynia.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |