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Motor Vehicle Accidents: the Most Common Cause of Traumatic Vertebrobasilar Ischemia

Published online by Cambridge University Press:  02 December 2014

Michel Beaudry  and
J. David Spence
Michel Beaudry
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
J. David Spence
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
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Abstract

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Background:

Recent media exposure of strokes from chiropractic manipulation have focused attention on traumatic vertebrobasilar ischemia. However, chiropractic manipulation, while the easiest cause to recognize, is probably not the most common cause of this condition.

Methods:

We reviewed all consecutive cases of traumatic vertebrobasilar ischemia referred to a single neurovascular practice over 20 years, from the office files and hospital records.

Results:

There were 80 patients whose vertebrobasilar ischemia was attributed to neck trauma. Five were diagnosed as due to chiropractic manipulation, but the commonest attributed cause was motor vehicle accidents (MVAs), which accounted for 70 cases; one was a sports injury, and five were industrial accidents. In some cases neck pain from an MVA led to chiropractic manipulation, so the cause may have been compounded. In most vehicular cases the diagnosis had been missed, even denied, by the neurologists and neurosurgeons initially involved. The longest delay between the injury and the onset of delayed symptoms was five years.

Conclusions:

Traumatic vertebrobasilar ischemia is most often due to MVAs; the diagnosis is often missed, in part because of the delay between injury and onset of symptoms and, in part, we hypothesize, because of reluctance of doctors to be involved in medicolegal cases.

Résumé:

RÉSUMÉ:Introduction:

La couverture médiatique récente des accidents vasculaires cérébraux causés par des manipulations vertébrales a attiré l'attention sur l'ischémie vertébro-basilaire traumatique. Bien que les manipulations vertébrales soient la cause la plus facile à identifier, elle n'est cependant pas la cause la plus fréquente de cette affection.

Méthodes:

Nous avons revu tous les dossiers cliniques au cabinet et à l'hôpital de cas consécutifs d'ischémie vertébro-basilaire traumatique référés à la même clinique de médecine neuro-vasculaire sur une période de 20 ans.

Résultats:

Chez 80 patients, l'ischemie vertébro-basilaire a été attribuée à un traumatisme cervical, dont cinq cas étaient dus à des manipulations vertébrales. La cause la plus fréquente était un accident de la route, soit 70 cas; chez un cas, il s'agissait d'une blessure sportive et chez cinq autres, d'accidents de travail. Dans certains cas, des douleurs cervicales dues à un accident de la route ont motivé les manipulations vertébrales de telle sorte que, dans ces cas, la cause était peut-être mixte. Dans la plupart des cas d'accidents de la route, le diagnostic n'avait pas été fait ou avait même été écarté par les neurologues et les neurochirurgiens consultés initialement. Le délai le plus long entre le traumatisme et le début des symptômes tardifs était de cinq ans.

Conclusions:

L'ischémie vertébro-basilaire traumatique est due la plupart du temps, à un accident de la route; souvent le diagnostic est manqué parce que d'une part il y a un délai entre le traumatisme et le début des symptômes et d'autre part, nous présumons, à cause de la réticence qu'éprouvent les médecins à s'impliquer dans les cas médicolégaux.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 4 , November 2003 , pp. 320 - 325
Copyright
Copyright © The Canadian Journal of Neurological 2003

References

1. Jeret, JS, Bluth, M. Stroke following chiropractic manipulation. Report of 3 cases and review. Cerebrovasc Dis 2002; 13(3):210–213.Google Scholar
2. Hart, RG, Easton, JD. Dissections of cervical and cerebral arteries. Symposium on cerebrovascular disease. Philadelphia: W. B. Saunders, 1983: 155–182.Google Scholar
3. Mokri, B, Piepgras, DG, Houser, W. Traumatic dissections of the extracranial internal carotid artery. J Neurosurg 1988; 68:189–197.Google Scholar
4. Sherman, DG, Hart, RG, Easton, JD. Abrupt change in head position and cerebral infarction. Stroke 1981; 12:2–6.Google Scholar
5. Jacome, DE. Basilar artery migraine after uncomplicated whiplash injuries. Headache 1986; 26:515–516.CrossRefGoogle ScholarPubMed
6. Haas, DC, Lourie, H. Trauma-triggered migraine: an explanation for common neurological attacks after mild head injury. Review of the literature. J Neurosurg 1988; 68:181–188.Google Scholar
7. Bogousslavski, J. Dissections of the cerebral arteries: clinical effects. Curr Opin Neurol Neurosurg 1988: 63–68.Google Scholar
8. Mas, JL, Bousser, MG, Hasbourn, D, Laplane, D. Extracranial vertebral artery dissections: a review of 13 cases. Stroke 1987; 19:1037–1047.Google Scholar
9. Caplan, LR, Zarins, CK, Hemmati, M. Spontaneous dissection of the extracranial vertebral arteries. Stroke 2002; 16:1030–1038.CrossRefGoogle Scholar
10. Scievink, WI. Current Concepts: Spontaneous Dissection of the Carotid and Vertebral Arteries. N Engl J Med 2001; 344:898–906.CrossRefGoogle Scholar
11. Mayer, SA, Rubin, BS, Starman, BJ, Byers, PH. Spontaneous multivessel cervical artery dissection in a patient with a substitution of alanine for glycine (G13A) in the 1(I) chain of type I collagen. Neurology 1996; 47:552–556.Google Scholar
12. Viktrup, L, Knudsen, GM, Hansen, SH. Delayed onset of fatal basilar thrombotic embolus after whiplash injury. Stroke 1995; 26:2194–2196.Google Scholar
13. Auer, RN, Krcek, J, Butt, JC. Delayed symptoms and death after minor head trauma with occult vertebral. J Neurol Neurosurg Psychiatry 1994; 57(4):500–502.Google Scholar
14. Nichelli, P, Gibertoni, M, Guerzoni, C. Delayed cerebellar infarction following a car accident. Stroke 1983; 14:617–619.Google Scholar
15. Tettenborn, B, Caplan, LR, Sloan, MA, et al. Postoperative brainstem and cerebellar infarcts. Neurology 1993; 43:471–477.CrossRefGoogle ScholarPubMed
16. Weintraub, MI. Beauty parlor stroke syndrome: report of five cases. JAMA 1993; 269:2085–2086.CrossRefGoogle ScholarPubMed
17. Van de Kelft, E, Kunnen, J, Truyen, L, Heytens, L. Postpartum dissecting aneurysm of the basilar artery. Stroke 1992; 23:114–116.CrossRefGoogle ScholarPubMed
18. Weintraub, MI, Khoury, A. Critical neck position as an independent risk factor for posterior circulation stroke. A magnetic resonance angiographic analysis. J Neuroimaging 1995; 5:16–22.CrossRefGoogle ScholarPubMed
19. Caplan, LR. Vertebrobasilar occlusive disease. In: Barnett, HJM, Mohr, JP, Stein, BM, Yatsu, FM, (Eds). Stroke. Pathophysiology, Diagnosis, and Management. New York: Churchill, Livingstone, 1986: 570.Google Scholar
20. Stopford, JSB. The arteries of the pons and medulla oblongata. J Anat 1916; 50:131–164.Google Scholar
21. Schneider, RC, Crosby, EC. Vascular insufficiency of brain stem and spinal cord in spinal trauma. Neurology 1959; 9:634–656.Google Scholar
22. Schneider, RC, Gosch, HH, Norrell, H, et al. Vascular insufficiency and differential distortion of brain and cord caused by cervicomedullary football injuries. J Neurosurg 1970; 33:363–375.CrossRefGoogle ScholarPubMed
23. Ommaya, AK, Faas, F, Yarnell, P. Whiplash injury and brain damage. JAMA 1968; 204:285–289.Google Scholar
24. Hughes, JT. Morphological changes in human cerebral arteries in relation to intracranial arterial spasm. I. In: Wilkins, RH, (Ed). Cerebral Arterial Spasm. Baltimore, London: Williams & Wilkins, 1979.Google Scholar
25. Winston, KR. Whiplash and its relationship to migraine. Headache 1987; 27:452–457.CrossRefGoogle ScholarPubMed
26. Sjaastad, O, Saunte, C, Hovdalh, H, et al. “Cervicogenic” headache. An hypothesis. Cephalalgia 1983; 3:249–256.Google Scholar
27. Haas, DC, Ross, GS. Transient global amnesia triggered by mild head trauma. Brain 1986; 109:251–257.Google Scholar
28. Fisher, CM. Whiplash amnesia. Neurology 1982; 32:667–668.Google Scholar
29. Hofstad, H, Gjerde, IO. Transient global amnesia after whiplash trauma. J Neurol Neurosurg Psychiatry 1985; 48:956–957.Google Scholar
30. Fisher, CM. Unusual vascular events in the territory of the posterior cerebral artery. Can J Neurol Sci 1986; 13:1–7.CrossRefGoogle ScholarPubMed
31. Olesen, J, Larsen, B, Lauritzen, M. Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine. Ann Neurol 1981; 9:344.Google Scholar
32. Bogousslavski, J, Regli, F, Van Melle, GV, et al. Migraine stroke. Neurology 1988; 38:223–227.Google Scholar
33. Thie, A, Spitzer, K, Lachenmayer, L, Kunze, K. Prolonged vasospasm in migraine detected by noninvasive transcranial Doppler ultrasound. Headache. 1988 Apr;28(3):183–186.Google Scholar
34. Vinchon, M, Assaker, R, Leclerc, X, Lejeune, JP. Vertebrobasilar insufficiency resulting from traumatic atlantoaxial instability: case report. Neurosurgery 1995; 36:839–841.Google Scholar