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Motor Vehicle Accidents: the Most Common Cause of Traumatic Vertebrobasilar Ischemia

Published online by Cambridge University Press:  02 December 2014

Michel Beaudry  and
J. David Spence
Michel Beaudry
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
J. David Spence
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
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Abstract

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Background:

Recent media exposure of strokes from chiropractic manipulation have focused attention on traumatic vertebrobasilar ischemia. However, chiropractic manipulation, while the easiest cause to recognize, is probably not the most common cause of this condition.

Methods:

We reviewed all consecutive cases of traumatic vertebrobasilar ischemia referred to a single neurovascular practice over 20 years, from the office files and hospital records.

Results:

There were 80 patients whose vertebrobasilar ischemia was attributed to neck trauma. Five were diagnosed as due to chiropractic manipulation, but the commonest attributed cause was motor vehicle accidents (MVAs), which accounted for 70 cases; one was a sports injury, and five were industrial accidents. In some cases neck pain from an MVA led to chiropractic manipulation, so the cause may have been compounded. In most vehicular cases the diagnosis had been missed, even denied, by the neurologists and neurosurgeons initially involved. The longest delay between the injury and the onset of delayed symptoms was five years.

Conclusions:

Traumatic vertebrobasilar ischemia is most often due to MVAs; the diagnosis is often missed, in part because of the delay between injury and onset of symptoms and, in part, we hypothesize, because of reluctance of doctors to be involved in medicolegal cases.

Résumé:

RÉSUMÉ: Introduction:

La couverture médiatique récente des accidents vasculaires cérébraux causés par des manipulations vertébrales a attiré l'attention sur l'ischémie vertébro-basilaire traumatique. Bien que les manipulations vertébrales soient la cause la plus facile à identifier, elle n'est cependant pas la cause la plus fréquente de cette affection.

Méthodes:

Nous avons revu tous les dossiers cliniques au cabinet et à l'hôpital de cas consécutifs d'ischémie vertébro-basilaire traumatique référés à la même clinique de médecine neuro-vasculaire sur une période de 20 ans.

Résultats:

Chez 80 patients, l'ischemie vertébro-basilaire a été attribuée à un traumatisme cervical, dont cinq cas étaient dus à des manipulations vertébrales. La cause la plus fréquente était un accident de la route, soit 70 cas; chez un cas, il s'agissait d'une blessure sportive et chez cinq autres, d'accidents de travail. Dans certains cas, des douleurs cervicales dues à un accident de la route ont motivé les manipulations vertébrales de telle sorte que, dans ces cas, la cause était peut-être mixte. Dans la plupart des cas d'accidents de la route, le diagnostic n'avait pas été fait ou avait même été écarté par les neurologues et les neurochirurgiens consultés initialement. Le délai le plus long entre le traumatisme et le début des symptômes tardifs était de cinq ans.

Conclusions:

L'ischémie vertébro-basilaire traumatique est due la plupart du temps, à un accident de la route; souvent le diagnostic est manqué parce que d'une part il y a un délai entre le traumatisme et le début des symptômes et d'autre part, nous présumons, à cause de la réticence qu'éprouvent les médecins à s'impliquer dans les cas médicolégaux.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 4 , November 2003 , pp. 320 - 325
Copyright
Copyright © The Canadian Journal of Neurological 2003

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