Development and Validation of a Diagnostic Support Tool for Early Recognition of Cervical Arterial Dissection
Apr
The relationship between neck manipulation and cervical artery stroke is obviously an important topic to discuss from both research and clinical perspectives. This is a topic I have covered in detail in both research reviews and E-Learning courses (see below). This week, a combo review of two papers on the development of a diagnostic support tool to assist early recognition of possible strokes in progress...
Cervical arterial dissection (CeAD) is the cause of strokes in up to 25% of people who are under 55 years-of-age and otherwise healthy. Although rare, CeAD may occur following cervical spine manipulation and, in some cases, may progress to ischemic stroke.
CeAD symptoms typically develop over time, beginning with headache and neck pain with no clear neurological signs at first, but they may develop days or even weeks later. Since the condition is initially difficult to diagnose, CeAD patients sometimes receive (what turns out to be) inappropriate musculoskeletal treatment for their neck pain. Furthermore, clear diagnostic criteria for CeAD are lacking and red flag features for neck pain and headache are vague.
A diagnostic decision tool is needed that could be used by clinicians to screen and risk-stratify patients who present with headache and/or neck pain. The tool could specify a threshold beyond which further investigation (ex. computed tomography [CT] or magnetic resonance [MR] angiogram) would be indicated.
This review discusses two papers. The aim of the first study was to develop an evidence-based diagnostic decision tool for early identification of cervical artery dissection and to determine which clinical characteristics should be included in the tool as well as to develop a simple scoring system and estimate the predictive utility of the tool. The second study (conducted by the same research team) was designed to validate the previously developed diagnostic decision tool for use in the early recognition of CeAD.
This week’s Research Review: Development and Validation of a Diagnostic Support Tool for Early Recognition of Cervical Arterial Dissection
The two papers featured in this review:
- Thomas LC, Holliday E, Attia JR & Levi C. Development of a diagnostic support tool for predicting cervical arterial dissection in primary care. Journal of Manual & Manipulative Therapy 2024; 32:2: 173-181.
- Thomas L, Fowler M, Marsh L, Holliday E, et al. Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care. Clinical Neurology and Neurosurgery 2024; 247: 108627.
You can now purchase single Research Reviews for only $4.99 – Get access to this review here
For more scientific and clinical learning on this topic, check out my 2-hour E-Seminar “The Dissection Connection: Is this patient having a stroke?“
I’ve included the first section of this course below…
