1/6. Clinical considerations in the chiropractic management of the patient with marfan syndrome.OBJECTIVE: To describe the chiropractic management of a patient with whiplash-associated disorder and a covert, concomitant dissecting aneurysm of the thoracic aorta caused by marfan syndrome or a related variant. CLINICAL FEATURES: A 25-year-old man was referred by his family physician for chiropractic assessment and treatment of neck injuries received in a motor vehicle accident. After history, physical examination, and plain film radiographic investigation, a diagnosis of whiplash-associated disorder grade I was generated. INTERVENTION AND OUTCOME: The whiplash-associated disorder grade I was treated conservatively. Therapeutic management involved soft-tissue therapy to the suspensory and paraspinal musculature of the upper back and neck. Rotary, manual-style manipulative therapy of the cervical and compressive manipulative therapy of the thoracic spinal column were implemented to maintain range of motion and decrease pain. The patient achieved full recovery within a 3-week treatment period and was discharged from care. One week after discharge, he underwent a routine evaluation by his family physician, where an aortic murmur was identified. Diagnostic ultrasound revealed a dissecting aneurysm measuring 78 mm at the aortic root. Immediate surgical correction was initiated with a polyethylene terephthalate fiber graft. The pathologic report indicated that aortic features were consistent with an old (healed) aortic dissection. There was no evidence of acute dissection. Six month follow-up revealed that surgical repair was successful in arresting further aortic dissection. CONCLUSION: The patient had an old aortic dissection that pre-dated the chiropractic treatment (which included manipulative therapy) for the whiplash-associated disorder. Manipulative therapy, long considered an absolute contraindication for abdominal and aortic aneurysms, did not provoke the progression of the aortic dissection or other negative sequelae. The cause, histology, clinical features, and management considerations in the treatment of this patient's condition(s) are discussed.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/6. Post-traumatic pseudoaneurysm of the common carotid artery. Importance of echo-Doppler evaluation of the intimal damage.Nonpenetrating traumas of the extracranial carotid artery are uncommon and frequently involve the carotid bifurcation. We report a case of asymptomatic post-traumatic pseudoaneurysm of the common carotid artery in a 32-year-old woman, detected by chance 12 years after a cervical injury. Of all the investigations, only echo-Doppler permitted the detection of an intimal tear at the level of the aneurysmatic dilatation. After aneurysmectomy, 8 mm PTFE graft replacement was carried out. We believe that routine use of echo-Doppler ultrasonography in all asymptomatic patients with a definite history of contusive cervical trauma should be recommended. In our opinion, the absolute surgical indication resulted from the local and neurological complications potentially stemming from the pseudoaneurysmatic dilatation.- - - - - - - - - - ranking = 36.922084376167keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
3/6. Transient short free running circadian rhythm in a case of aneurysm near the suprachiasmatic nuclei.A free running circadian rest-activity cycle is rare in sighted individuals living in a normal environment. Even more rare is a periodicity shorter than 24 hours, as observed in actigraphic recordings in a female patient during convalescence after a whiplash injury in a car accident. The documented free running period was 22.5 hours for 19 days. During the subsequent weeks re-entrainment occurred following re-establishment by a social zeitgeber, with a slightly early circadian phase of nocturnal melatonin onset relative to a late sleep period. magnetic resonance imaging and cerebral angiography showed an aneurysm at the bifurcation of the right internal carotid artery, close to the circadian pacemaker structure (the suprachiasmatic nuclei), which was later occluded.- - - - - - - - - - ranking = 1.6666666666667keywords = aneurysm (Clic here for more details about this article) |
4/6. Internal carotid artery stenosis due to atherosclerotic plaque damage after whiplash injury.Blunt traumatic occlusion or stenosis of the internal carotid artery is a rare complication of whiplash injury and may not be recognized until the onset of neurological symptoms. The clinical course can vary considerably, with regard to both the symptoms and the interval between injury and manifestation. A dissecting aneurysm and intimal tear are usually observed after blunt internal carotid artery injury. Atherosclerotic plaque is often observed in the cervical internal carotid artery and carotid bifurcation, but involvement of plaque has been confirmed in relatively few cases of blunt traumatic internal carotid injury. We describe a 58-year-old man who developed cerebral embolism due to intraplaque thrombus after a minor whiplash injury and was successfully treated with carotid endarterectomy. Because thrombosis occurred within the atherosclerotic plaque, we named the mechanism of this case "plaque injury".- - - - - - - - - - ranking = 0.33333333333333keywords = aneurysm (Clic here for more details about this article) |
5/6. dissection of the extracranial vertebral artery: report of four cases and review of the literature.Four cases of cervical vertebral artery (VA) dissection are reported. In three patients VA dissection was associated with neck trauma. All patients were young or middle-aged (range 27 to 49 years). In two there was a history of migraine. pain preceded neurological symptoms from hours to six weeks. Three patients had neurological deficits including elements of the lateral medullary syndrome, and one experienced recurrent transient ischaemic attacks in the vertebrobasilar territory. Angiographic findings included irregular stenosis, occlusion and pseudoaneurysm; in two patients VA abnormalities were bilateral. All patients were treated with anticoagulants and improved. In a review of 28 cases with traumatic dissection and 29 cases with spontaneous dissection of the VA reported in the literature, distinct clinical and angiographic features emerge. Aetiology remains obscure in most cases of spontaneous dissection and management is still controversial.- - - - - - - - - - ranking = 6.0425696182501keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
6/6. Traumatic aneurysm of the extracranial internal carotid artery due to hyperextension of the neck.Aneurysms of the extracranial internal carotid artery (ICA) are rare. The majority arise iatrogenically after surgery, but a few follow trauma. Traumatic aneurysms of the ICA may follow penetrating injury, direct "blunt trauma" injury or hyperextension of the neck. We report a case of traumatic ICA aneurysm which probably followed a hyperextension injury to the cervical spine in a young woman.- - - - - - - - - - ranking = 2keywords = aneurysm (Clic here for more details about this article) |