Epidemiology Vertebrobasilar artery insufficiency
Vertebrobasilar artery insufficiency
|Vertebrobasilar artery insufficiency||The cervical arteries are most vulnerable when the head is rotated. 2,3
Vertebral arteries emerge from the cervical foramina, run along the grooves in the superior aspects of the posterior arch of the atlas and then through the posterior atlanto-occipital membrane before entering the dura.
|Sex||Slightly more often for women than for men 84 > 67.1|
|Age||Mean age was 38.1|
|Pain location||Neck / Occiput|
|Pain sensation / Symptoms||Classic Cardinal Signs of Vertebrobasilar Compromise: Five Ds and Three Ns
Dizziness, Drop attacks, Diplopia, Dysarthria, Dysphagia, Ataxia of gait, Nausea, Numbness(ipsilateral face and/or contralateral body) and Nystagmus4
|Blood flow||According to Chrost(1984) and Hillen and Fonville(1980) there is a reduction in blood flow in the vertebral artery during physiologic movement of the cervical spine even in the absence of any anomaly or pathology. Rotation of the cervical spine seems to have a particularly marked effect in reducing blood flow in the contralateral(opposite side) vertebral artery (by lengthening the artery).
According to Hillen and Fonville(1980) side bending gives a relatively small reduction in blood flow during side bending. According to Hillen and Fonville (1980) and Penning(1978), flexion and extension of the cervical spine gives no reduction in blood low (Does not lengthen the artery).4
Reduction in blood flow According to Chrost, referenced by Gutmann and Biedermann (1984)4
|History of injury||The most common site of injury to the vertebral artery caused by cervical spine manipulation appears to be at the site of the atlanto-occipital joint, this is where the artery changes its vertical course to a horizontal course.2,3
Interruption of the flow in one of the vertebral arteries or the basilar artery can result in signs and symptoms related to the dependent parts of the central nervous system.2
|Purpose of the test of Kleyn Nieuwenhuyse*
Exclusion of a possible problem with the vertebral artery, in the cervical spine.
|Description test kleyn Nieuwenhuyse
Starting position: patient lies on his or her back
Please ensure that when a left rotation the permeability of a right a.vertebralis is tested. The left artery is concluded, the right artery is examined whether it has sufficiently permeable to take over the function.
Evidence Based Practice
|Title, Author, Year||Article||Article Quality||Specificity||Sensetivity|
|1 Coté et. Al. the validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis. Journal of manipulative and physiological therapeutics 19 (3) 1-11||Diagnostic accuracy study||QUADAS 8/14||0.67-0.96 Extension-rotation
(with rotation to the left)
|1 Coté et. Al. the validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis. Journal of manipulative and physiological therapeutics 19 (3) 1-11||Diagnostic accuracy study||QUADAS 8/14||0.49-0.81
(with rotation to the right)
|2 Sakaguchi et. Al. (2003) mechanical compression of the extracranial vertebral artery during neck rotation. Neurology 2003 (61) 845-847||Diagnostic accuracy study||QUADAS 7/14||0.97-0.99
|3 Li Yi-Kai et. Al. (1999) changes and implications of blood flow velocity of the vertebral artery during rotation and extension of the head. Journal of manipulative and physiological therapeutics 22(2) 91-95||Diagnostic accuracy study||QUADAS 6/14||0.75-1.00
|4 B. Petersen et al. (1996)
Basilar artery blood flow during head rotation in vertebrobasilar ischemia. Acta Neurol Scand. 1996;94(294):301
|Diagnostic accuracy study||QUADAS 9/14||0.97-0.99