Featured

 Don’t mess with your neck doing yoga either

The mechanisms of all of these injuries and that of neck hyperextension by a chiropractor are similar, and have to do with an unfortunate quirk of neck anatomy...

 How Yoga Can Wreck Your Body

Extreme motions of the head and neck...could wound the vertebral arteries, producing clots, swelling and constriction, and eventually wreak havoc in the brain...

 Losing My Mind (And Dream) to Pulsatile Tinnitus: The Less Noisy Road Back

The most common noises are ringing, hissing, and roaring, or some combination of them. While "popular" tinnitus exhibits this classic acoustic behavior, and can only be perceived by the subject, the kind I was, and still am, afflicted by is categorically distinct.

 My Stroke of Luck

Twenty-two months ago, I interrupted my nonstop reporting about paths toward a sustainable future for our species to focus on sustaining myself. The hiatus was not by choice, but was mandated by a stroke — the out-of-the-blue variant, the rare kind of “brain attack” (the term preferred by some neurologists) that is most often seen in otherwise healthy, youngish middle-aged people.

Articles of Interest

CADISS: a feasibility trial that answered its question

The Cervical Artery Dissection in Stroke Study (CADISS) was the first randomised clinical trial to compare anticoagulation with antiplatelet treatment for cervical artery dissection. It was designed as a pilot study, aiming to estimate the risk of recurrent stroke reliably and establish whether a definitive trial would be feasible. The main results, published in The Lancet Neurology,10 are much the same as those from the other anticoagulation trials—any reduction in ischaemic stroke was counterbalanced by an increase in haemorrhages. However, events were rare, with only four ischaemic strokes (three in the antiplatelet group and one in the anticoagulant group) and one subarachnoid haemorrhage (in the anticoagulant group) among the 250 participants. The rarity of events meant that the study did not answer the question of which strategy was superior overall, but that was not expected from this pilot trial.

emDocs

Pearls •Should always consider carotid/cervical dissection as cause of ischemic symptoms in patients that are young, lack risk factors for thrombotic/embolic stroke, or complaining of neck pain •Trauma patients with significant head/neck trauma and neurologic deficits, should evaluate for carotid or vertebral artery dissection •Consider carotid dissection in patients presenting with neck pain or headache that started in the context of activities that cause torsion or blunt trauma to neck

Focus On: Headache and Neck Pain - When to Suspect Cervical Artery Dissection

Up to 80% of cervical artery dissections are preceded by trauma to the head or neck.3 Dissection has been associated with chiropractic manipulation, weight lifting, roller coasters, and wrestling...Dissection has been reported following activities as innocuous as shaving, vomiting, yoga, massage, nose blowing, and swimming. Symptoms usually start immediately after the traumatic event, although some patients may not experience any symptoms for a week. The average time from traumatic event to onset of symptoms is 2-3 days.6 What further complicates the diagnosis is that the typical ED evaluation of a new headache – non-contrast computed tomography (CT) scan of the head and possible lumbar puncture – will miss most cases of dissection.

WikEM

Most frequent cause of CVA in young and middle-aged patients (median age - 40yrs).Symptoms may be transient or persistent. Consider in trauma pt who has neurologic deficits despite normal head CT. Consider in pt w/ CVA + neck pain. Risk Factors: Neck trauma (often minor), Coughing, Connective tissue disease, History of migraine.

Resources

NeuroAngio.org

A dissection happens when, for some reason, the inside of the artery — the “intima” is torn. You can think of it as a skin cut, only on the inside.