Cervical Arterial Dysfunction
1. Introduction
Cervical arterial dysfunction (CAD) is an umbrella term for rare vascular problems of the neck. There are a range of blood vessels in the body that transport blood to different regions. In relation to cervical arterial dysfunction, this presentation can start from varied sources. An acute injury, such as neck trauma from a road traffic collision or impact from a rugby tackle, can cause trauma to the blood vessels. As a result, this can cause damage to the vessel itself, restricting blood flow or the opposite where blood flow is increased (1).
Non-traumatic presentations are usually linked to comorbidities (other conditions) and it is important to note that rarely is this a single causal factor but more multi-factorial in nature (1). What this means is that patients who are more at risk would have previous vascular medical history, such as a long history of smoking or high blood pressure, that could contribute to having cervical arterial dysfunction (1,2,3).
We ensure that regular training with our therapists is carried out so we can recognise patients presenting with cervical arterial dysfunction and refer them through the correct treatment pathway.
Frequently Asked Questions
- Cervical arterial dysfunction (CAD) is an umbrella term for rare vascular problems of the neck.
- Rare.
- Research shows that 2.6 – 3 incidents are reported per year per 100,000 people (1).
- Moderately.
- Cervical arterial dysfunction can be a serious presentation and any development of signs/symptoms must be taken seriously as they may develop into more serious conditions such as a stroke.
- People who are obese.
- Smokers.
- Previous heart/vascular conditions.
- People older than 50 (2).
- Neck and head pain.
- Headaches.
- Dizziness.
- Blurred vision.
- Balance disturbance.
- Speech or swallowing issues.
- Increase in blood pressure.
- Facial numbness.
- Nystagmus (involuntary eye movements).
- Feeling sick or faint.
- Loss of taste (1,2,3).
- Go to your local GP or physiotherapist. If your symptoms are worsening or concerning, go to the accident and emergency department.
- As treatment is varied, it is estimated that a full recovery is expected between 3-6 months.
- Patients recover well if treatment is conducted early.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
There can be varied signs and symptoms which are categorised into early and late.
Early – acute neck pain can be severe, headache, tenderness of the jaw, difficulty in chewing or tongue pain. Increase in blood pressure and awareness that you simply just do not feel right. May have weird, worsening reaction to treatment such as massage or manipulation from a therapist (3).
Late – Worsening neck pain, feeling hot and blood pressure is increased. Retinal dysfunction such as blurred vision, double vision or dizziness, facial numbness, vomiting, speech and swallowing difficulty, sudden blindness, tinnitus. At worst, you may suffer a stroke (3).
3. Causes
- Traumatic – road traffic collision, impact injury from sport or a fall.
- Non-traumatic – older population, smoking habits, poor lifestyle such as diet/nutrition, overweight, previous stroke and vascular presentations like hypertension (1,2).
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing cervical arterial dysfunction. It does not mean everyone with these risk factors will develop symptoms (2, 5).
- Past history of trauma to cervical spine/cervical vessels.
- History of migraine-type headache.
- Hypertension.
- Hypercholesterolemia/hyperlipidemia.
- Cardiac disease, vascular disease, previous cerebrovascular accident or transient ischaemic attack.
- Diabetes mellitus.
- Blood clotting disorders/alterations in blood properties (e.g. hyperhomocysteinemia).
- Anticoagulant therapy.
- Long-term use of steroids.
- History of smoking.
- Recent infection.
- Immediately postpartum (following childbirth).
- Trivial head or neck trauma.
- Absence of a plausible mechanistic explanation for the patient’s symptoms.
5. Prevalence
The prevalence of cervical arterial dysfunction is low and the incidence of the disease is relatively low in the general population, estimated at around 2.6-3 out of 100,000 individuals per year (1). It can affect all age groups – internal carotid artery dissection is more common in those between the ages 34-54 and vertebral artery dissection in those over the age of 55 (1).
6. Assessment & Diagnosis
As with every type of problem, a detailed subjective (verbal questioning) and objective assessment (physical tests) will be carried out with your GP or physiotherapist. With cervical arterial dysfunction, there are subjective questions that will allow the clinician to assess the risk of you having or developing cervical arterial dysfunction. If there is any suspicion you will be sent to the hospital for further investigations which are:
- An MRI (magnetic resonance imaging) scan or a CT (computed tomography) scan. These create detailed images of your head and neck. Both scans are sometimes done with an angiogram. During an angiogram, dye is injected into your arteries. This helps your doctor to see them in more detail (4).
- An ultrasound scan of your arteries. This is a scan that uses sound waves to produce an image of your blood vessels (4).
It is important to know that diagnosis and early treatment are vital to avoid any more serious events such as a stroke.
7. Self-Management
Once cervical artery dysfunction has been diagnosed and addressed, self-management is vital for preventing any reoccurrence. It is important to note that lifestyle changes made should be long-term. This can be giving up smoking, losing weight or just simply being more active in your lifestyle. Physiotherapists are best suited to advise and help you with this and can also refer you to various other professionals to help make these important changes.
8. Rehabilitation
Below are three programmes of exercises that are aimed at assisting with the overall management of your condition. Although they will not always cure the condition, research tells us that activity of this nature will be helpful in minimising the effect of the condition.
9. Cervical Arterial Dysfunction
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
These exercises focus on the basic range of motion of the neck. Pain should not exceed 3/10 on your perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, an assessment will be made by the physiotherapist to check your strength, range of movement, stability and general functional capacity to be safe enough for a return to sport. Before returning to sport, a rehabilitation programme should ideally incorporate some contact drills and exercises that mimic the sport you participate in.
As part of a comprehensive treatment approach, your physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from further assessment to ensure you are making progress and to establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
Medical treatments usually work well so surgery is only considered in very exceptional circumstances. If, for example, you cannot take anticoagulant or antiplatelet medicines or medicines are not working for you, your doctor may suggest an angioplasty and stenting procedure to help prevent blood clots forming.
An angioplasty involves putting a balloon into a narrow or blocked artery to widen it. A stent is a mesh tube inserted into the artery so that blood can still flow through it easily once the balloon has been removed. Other surgical procedures are possible, but again are only considered necessary on very rare occasions (6).
12. Links for Further Reading
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References
- Be´jot Y., Daubail B., Debette S., Durier, J. & Giroud, M. (2014). Incidence and outcome of cerebrovascular events related to cervical artery dissection: the Dijon Stroke Registry. International Journal Stroke. doi: 10.1111/ijs.12154.
- Ruston, A., Rivett, D., Carlesso, L., Flynn, T., Hing, W. & Kerry, R. (2014). International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention. Manual Therapy. 19(3), 222-228. https://doi.org/10.1016/j.math.2013.11.005.
- Kerry, R., Taylor, A. J., Mitchell, J., McCarthy, C., & Brew, J. (2008). Manual therapy and cervical arterial dysfunction, directions for the future: a clinical perspective. The Journal of manual & manipulative therapy. 16 (1), 39–48. https://doi.org/10.1179/106698108790818620.
- Cury M., Greenberg R. K, Morales J. P., Mohabbat, W. & Hernadez, V. A. (2009). Supra-aortic vessels aneurysms: diagnosis and prompt intervention. Journal of Vascular Surgery. 49, 4-10.
- Thomas, L. C., Rivett, D. A., Attia, J. R & Levi, C. (2015). Risk Factors and Clinical Presentation of Cervical Arterial Dissection: Preliminary Results of a Prospective Case-Control Study. Journal of Orthopaedic & Sports Physical Therapy. 45 (7), 503-511.
- Kerry, R & Taylor, A. J. (2009). Cervical Arterial Dysfunction: Knowledge and Reasoning for Manual Physical Therapists. Journal of Orthopaedic & Sports Physical Therapy. 39 (5).
Other Conditions in
Neck, Orthopaedics
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An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
Thoracic Outlet Syndrome
A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.
Neck Pain
Pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms.
Cervical Spinal Stenosis
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Cervical Radiculopathy
Nerve pain originating from the neck and causing pain, altered sensation or weakness in the arm.
Cervical Disc Dysfunction
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Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Acute Torticollis
Sometimes referred to as “wry neck”, this is a condition causing muscle spasms and associated neck pain.