Trager Robert J, Troutner Alyssa M, Pikus Harold J, Daniels Clinton J, Dusek Jeffery A
Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA.
Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA.
Cureus. 2023 Dec 29;15(12):e51297. doi: 10.7759/cureus.51297. eCollection 2023 Dec.
Early symptoms of vertebral artery dissection (VAD) may be nonspecific, including neck pain and headache. Neck pain and headache are also common reasons for patients to seek chiropractic care. We hypothesized that neck pain and/or headache would be the most prevalent symptoms among patients with undiagnosed VAD presenting to chiropractors compared to dizziness or other symptoms. We searched PubMed, Ovid, the Index to Chiropractic Literature, Google Scholar, and gray literature through September 2023 for observational studies describing patients aged ≥10 with previously undiagnosed VAD presenting to a chiropractor. Article selection, data extraction, and quality assessment were performed in duplicate. We synthesized the point prevalence of symptoms and other clinical features. We included 10 case reports describing 10 patients (mean age = 37, SD = 7, 60% female). All patients had either neck pain or headache (100%; 95% confidence interval (CI) = 100%-100%). The most prevalent individual symptoms were neck pain (90%; 95% CI = 71%-100%), headache (80%; 95% CI = 55%-100%), visual disturbance (50%; 95% CI = 19%-81%), and dizziness (40%; 95% CI = 10%-70%). The certainty of results was very low due to publication bias. While our findings suggest that neck pain and/or headache are the most prevalent symptoms among patients with undiagnosed VAD visiting a chiropractor, the small sample size and reliance on case reports preclude any definitive conclusions. Further research with larger sample sizes, control groups, and better control of confounders is required to corroborate these results. Chiropractors should be aware of VAD features and refer suspected patients for emergency care.
椎动脉夹层（VAD）的早期症状可能不具有特异性，包括颈部疼痛和头痛。颈部疼痛和头痛也是患者寻求脊椎按摩治疗的常见原因。我们推测，与头晕或其他症状相比，颈部疼痛和/或头痛将是向脊椎按摩师就诊的未确诊VAD患者中最普遍的症状。我们检索了截至2023年9月的PubMed、Ovid、脊椎按摩文献索引、谷歌学术以及灰色文献，以查找描述年龄≥10岁的未确诊VAD患者向脊椎按摩师就诊的观察性研究。文章筛选、数据提取和质量评估均重复进行。我们综合了症状和其他临床特征的点患病率。我们纳入了10篇病例报告，描述了10名患者（平均年龄 = 37岁，标准差 = 7，60%为女性）。所有患者均有颈部疼痛或头痛（100%；95%置信区间（CI）= 100% - 100%）。最常见的个体症状为颈部疼痛（90%；95%CI = 71% - 100%）、头痛（80%；95%CI = 55% - 100%）、视觉障碍（50%；95%CI = 19% - 81%）和头晕（40%；95%CI = 10% - 70%）。由于发表偏倚，结果的确定性非常低。虽然我们的研究结果表明，颈部疼痛和/或头痛是未确诊VAD且前往脊椎按摩师处就诊的患者中最普遍的症状，但样本量小以及依赖病例报告妨碍了得出任何确定性结论。需要进行更大样本量、设立对照组并更好地控制混杂因素的进一步研究来证实这些结果。脊椎按摩师应了解VAD的特征，并将疑似患者转诊至急诊。
