Occasionally, I stumble across something I should have written about long ago. This is one of those articles, particularly relevant to chiropractors, that I don't recall reading anything about when it was published over a year ago. So...pardon my tardiness. It's not exactly cutting edge news, but definitely worth knowing. I hope you find it informative.
Mark R Payne DC
Author/Editor Science In Brief
This study from Lancet Neurology (Jan 2013)looked 1141 patients who suffered confirmed ischemic stroke in an effort to determine the relationship between transient early neurological symptoms and subsequent stroke events. The authors classified brainstem symptoms such vertigo, isolated double vision, feelings of generalized weakness, and disturbances of binocular vision as TNA's (Transient Neurological Attacks) in the area of the brain supplied by the vertebrobasilar circulation. Limb shaking, transient loss of vision (atypical amaurosis fugax) were classified as TNA's in the region of the brain affected by the carotid circulation while slurred speech, migraine headache, transient confusion and hemisensory tingling were considered as TNAs in "uncertain territory".
Of 1034 stroke patients where the affected vascular territory could be confirmed, 275 suffered vertebrobasilar stroke and 759 suffered carotid stroke. Isolated TNAs were found to have been more frequent in 16.3% (45/275) of the vertebrobasilar stroke victims particularly in the two days prior to the actual stroke event. Conversely, in carotid stroke cases, only 10 out of out of 759 experienced increased TNA symptoms. It's important to note that only 8% of all patients exhibiting TNAs were actually severe enough to meet the established criteria for classification as TIAs (Transient Ischemic Attacks). Of those patients who did experience TNA symptoms, only 10 (22%) actually sought medical attention prior to their stroke. Of those who sought medical attention, a vascular cause was suspected in only a single case.
Transient neurological brainstem symptoms are fairly common in patients who will subsequently suffer vertebrobasilar stroke events. Most of these events will not be so profound as to be classified as true TIA events. Given the current medico-legal environment in which chiropractors may well get blamed for vertebrobasilar strokes occurring while the patient is under their care, DC's should be very aware of those TNA symptoms of vertigo, isolated double vision, feelings of generalized weakness, and disturbances of binocular vision associated with the vertebrobasilar circulation. TNA symptoms may well be the only early warning that your patient may be about to suffer a full blown ischemic stroke event.
Author: Mark R Payne DC
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