Iatrogenic neurological deficit constitutes the greatest risk during therapeutic embolization in the vascular territories of the carotid and vertebral arteries. Constant monitoring of the patient's neurological status is therefore essential. The authors discuss the use of medical hypnosis to circumvent general anesthesia and to reduce chemical sedation to a minimum. Their experience with this technique is presented.
Vertebral artery dissection has been previously reported following minor head and neck trauma. Such activities as rapid head turning, tennis, yoga, and vigorous exercise have been implicated. We report a case of vertebral artery dissection following minor neck trauma suffered in a volleyball game. The anatomy of the vertebral artery, pathophysiology of dissection, and emergency department recognition and treatment of this disorder are discussed.
The American Journal of Forensic Medicine and Pathology
Treatment for individuals suffering from migraines and pain due to an inflammation or impingement of a nerve range from noninvasive methods such as massage, physical therapy, and medications to invasive methods such as epidural steroid injections and surgery. Each method of treatment has an associated level of risk. While minor to moderate complications from such procedures do occur, deaths are very rare. We report the first cited case of a death associated with the pain management procedure called nerve root block, also referred to as a transforaminal epidural steroid injection.
A vertebral artery pseudoaneurysm accompanied by serious neurological injury was seen in a 42-year-old woman who had undergone chiropractic manipulation of the neck. Such manipulation is a potential cause of neurological injury due to trauma to the cervical spine and the major vessels of the neck. The arterial pattern in this case was similar to that of angiodysplasia except for narrowing and irregularity of the vertebral artery.
Schweizer Archiv Für Neurologie, Neurochirurgie Und Psychiatrie = Archives Suisses De Neurologie, Neurochirurgie Et De Psychiatrie
Five cases of occlusion of the vertebral artery in context with mechanical stress - from endogene reasons in one case - and lesions of the vessel walls (in three cases) are recorded. The inferior posterior cerebellar artery was involved in all cases. Variable ischemic lesions resulted in the medulla oblongata and in the cerebellum, which were survived up to four weeks in one case. In the others death occurred within few hours or suddenly and unexpectedly. Related neurological symptoms were absent in one case only.
A case of labyrinthine failure due to trauma to the cervical vertebrae and its successful chiropractic management is reported. Various pathogenic theories are discussed, and the chiropractic theory explained.
Vigorous gymnastics and repeated manipulations of the cervical spine by a chiropractor were associated with headaches and transient cranial nerve deficits in a 7-year-old boy who had a history of birth trauma. Progressive cerebellar dysfunction was later accompanied by a visual field defect. A computerized axial tomography scan revealed a cerebellar infarction, and arteriograms showed vertebral and basilar occlusions.
A 23-year-old woman developed brainstem infarction following cervical manipulation. Vertebral angiography showed total occlusion of the left vertebral artery with a thrombus extending into the basilar artery. The literature dealing with this rare but serious complication of cervical manipulation is reviewed.
Previous case reports of vertebral-basilar system infarction following chiropractic cervical manipulation have emphasized the role of predisposing factors such as cervical spondylosis, atherosclerosis, and congenital asymmetry of the posterior circulation. Ten patients without prior neurologic symptoms had vertebral-basilar system infarction promptly after chiropractic maneuvers. One patient, who was free of clinical and radiographic evidence of predisposing factors, subsequently died.