This is a positive case report by Futch et al on proper clinical reasoning for a young female seeking out chiropractic services for headache, which turned out to be an acute left vertebral artery dissection. “Myth Exploded” as a catchline may be a little extreme but nevertheless, was published in BMJ Case Reports. The statement in the article, “no manipulation was performed” is appropriate but limited….as any type of mechanical treatment or assessment (AROM, premanipulative testing, etc.) would be inappropriate in this case. The patient’s symptomology should, and did in this case, raise a flag.
patient stated that the left-sided headache was atypical —“like nothing I’ve ever experienced before.”
No additional diagnostic or screening tests were performed (such as CN assessment, BP assessment), but overall shows proper reasoning based on subjective information (very different headaches than previous ones). These type of objective tools may not be necessary if subjective information makes your candle wick wiggle.
Written by Dr. Rich, a RN, this is a short but helpful clinical review of detecting carotid bruits. This type of diagnostic procedure is not pushed in our field, but can be useful to detect alteration in turbulent flow, which can provide additional information about the integrity of the vessel in question. It is not a good screen at all, but could add some specificity (rule-in) to your examination prior to referring out for more accurate diagnostic tests. Although this would not have helped in the above case report (carotid vs vertebral artery), a manual and/or vestibular therapist should be aware of this procedure.
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