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Spontaneous cervicocephalic arterial dissection with headache and neck pain as the only symptom

PainSci » bibliography » Maruyama et al 2012
updated
Tags: diagnosis, harms, neck, headache, chiropractic, spinal adjustment, random, pain problems, head/neck, spine, head, manual therapy, treatment, controversy, debunkery

Five articles on PainSci cite Maruyama 2012: 1. The Complete Guide to Chronic Tension Headaches2. The Complete Guide to Neck Pain & Cricks3. What Happened To My Barber?4. Does Spinal Manipulation Work?5. When to Worry About Neck Pain … and when not to!

PainSci notes on Maruyama 2012:

A small study of just 7 patients with pain as the only symptom of spontaneous cervical artery dissection. There was disconcerting variety in presentation, but the pain was consistently severe, unfamiliar, unilateral, and mostly sudden onset. “Cervicocephalic arterial dissection should be suspected when patients complain of intense unilateral posterior cervical and occipital pain or temporal pain.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND AND OBJECTIVE: Cervicocephalic arterial dissection can cause both ischemic stroke and hemorrhagic stroke. However, spontaneous cervicocephalic arterial dissection presenting only with headache and neck pain has rarely been reported. The clinical features of patients with spontaneous cervicocephalic arterial dissection presenting only with headache and neck pain were investigated.

METHODS: The subjects were seven patients with spontaneous cervicocephalic arterial dissection with headache and neck pain alone who were admitted to our hospital during the past 3 years. The clinical features of these patients were investigated. The diagnosis of arterial dissection was based on the criteria of the Strategies Against Stroke Study for Young Adults in Japan.

RESULTS: The age of the patients (3 males, 4 females) ranged from 35 to 79 (mean, 51.0 ± 16.2) years. Six patients had vertebral artery dissection, one had internal carotid artery dissection, and one had an association of vertebral and internal carotid artery dissection. With the exception of one patient, the headache and neck pain were unilateral. All patients with vertebral artery dissection complained of posterior cervical or occipital pain. In the cases of internal carotid artery dissection, one patient complained of temporal pain, and one patient with co-existing vertebral artery dissection complained of posterior cervical pain. The mode of onset was acute in five patients, thunderclap in one, and gradual and progressive in one. The pain was severe in all cases. Five patients complained of continuous pain, while two had intermittent pain. The quality of the pain was described as throbbing by five patients and constrictive by two. The headache and neck pain persisted for 1 week or longer in six of the seven patients.

CONCLUSION: Cervicocephalic arterial dissection should be suspected when patients complain of intense unilateral posterior cervical and occipital pain or temporal pain.

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