| 2017 |
Thomas LC, Hall LA, Attia JR, Holliday EG, Markus HS, Levi CR, 'Seasonal Variation in Spontaneous Cervical Artery Dissection: Comparing between UK and Australian Sites', Journal of Stroke and Cerebrovascular Diseases, 26 177-185 (2017)
© 2017 National Stroke Association Background Cervical artery dissection (CAD) is a lea ding cause of stroke among middle-aged adults, but the etiology is unclear. Some reports o... [more] © 2017 National Stroke Association Background Cervical artery dissection (CAD) is a lea ding cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of seasonal variation in CAD incidence have been suggested but may reflect extreme climatic conditions. Seasonal variation may implicate more transient seasonal causes such as proinflammatory or hypercoagulable states. This study aimed to assess whether CAD incidence varied with season between UK and Australian sites. Also, this study aimed to determine whether there was a different pattern of seasonal variation between arteries (carotid and vertebral) and any association between CAD incidence and clinical factors. Methods This was a retrospective observational study of patients older than 18 years with radiological diagnosis of internal carotid or vertebral arterial dissection, from sites in Australia and the UK. Clinical variables were compared between autumn-winter and spring-summer and site of dissection. Results A total of 133 CAD cases were documented in Australia and 242 in the UK. There was a seasonal pattern to CAD incidence in countries in both the northern and the southern hemispheres, with a trend for dissection to occur more commonly in autumn, winter, and spring than in summer (incidence rate ratios [IRR] 1.4-1.5, P¿ < ¿.05). CAD counts were also slightly higher in internal carotid than in vertebral artery (IRRs 1.168, 1.43, and 1.127, respectively). Neither systolic blood pressure nor pulse pressure was significantly associated with CAD counts. Conclusions CAD occurs more commonly in cooler months regardless of geographical location, suggesting transient seasonal causes may be important in the pathophysiology. This effect was slightly higher in internal carotid than in vertebral artery, suggesting differing trigger mechanisms between dissection sites.
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| 2016 |
Thomas LC, 'Cervical arterial dissection: An overview and implications for manipulative therapy practice', Manual Therapy, 21 2-9 (2016)
© 2015 Elsevier Ltd. Introduction: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to mino... [more] © 2015 Elsevier Ltd. Introduction: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to minor trauma or infection. The incidence is difficult to determine accurately as not all CAD progress to stroke. CAD is the most catastrophic adverse event associated with cervical manipulative therapy but it is rare. Early features of CAD can mimic a painful musculoskeletal presentation and a patient may present for treatment of neck pain and headache with a dissection in progress. Whether the manipulative technique is responsible for dissection or whether the diagnosis of CAD has been missed is unclear. Identification of individuals at risk, or early recognition of CAD could help expedite medical intervention and avoid inappropriate treatment. Purpose: The aims of this masterclass are to outline current research into the pathophysiology, aetiology and clinical presentation of CAD, to place the risk in context in a manipulative therapy setting and to discuss its possible clinical recognition. Implications: For those patients presenting with recent onset, moderate to severe unusual headache or neck pain, clinicians should perform a careful history, in particular questioning about recent exposure to head/neck trauma or neck strain. Cardiovascular factors may not be particularly useful indicators of risk of dissection. Clinicians should also be alert to reports of transient neurological dysfunction such as visual disturbance and balance deficits, arm paraesthesia and speech deficits, as these may be subtle. If clinicians suspect arterial dissection is in progress patients should be urgently referred for medical evaluation.
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| 2015 |
Thomas L, McLeod L, Osmotherly PG, Rivett DA, 'The effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: A sub analysis of an MRI study', Manual Therapy, 20 475-480 (2015) [C1]
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| 2015 |
Thomas LC, Rivett DA, Attia JR, Levi C, 'Risk factors and clinical presentation of cervical arterial dissection: Preliminary results of a prospective case-control study', Journal of Orthopaedic and Sports Physical Therapy, 45 503-511 (2015) [C1]
Copyright ©2015 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved. STUDY DESIGN: Cross-sectional case-control study. OBJECTIVES: To identify risk factors ... [more] Copyright ©2015 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved. STUDY DESIGN: Cross-sectional case-control study. OBJECTIVES: To identify risk factors and clinical presentation of individuals with cervical arterial dissection. BACKGROUND: Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is considered to involve pre-existing arterial susceptibility and a precipitating event, such as minor trauma. Identification of individuals at risk or early recognition of a dissection in progress could help expedite medical intervention and avoid inappropriate treatment. METHODS: Participants were individuals 55 years of age or younger from the Hunter region of New South Wales, Australia with radiologically confirmed vertebral or internal carotid artery dissection and an age- and sex-matched comparison group. Participants were interviewed about risk factors, preceding events, and clinical features of their stroke. Physical examination of joint mobility and soft tissue compliance was undertaken. RESULTS: Twenty-four participants with cervical arterial dissection and 21 matched comparisons with ischemic stroke but not dissection were included in the study. Seventeen (71%) of the 24 participants with dissection reported a recent history of minor mechanical neck trauma or strain, with 4 of these 17 reporting recent neck manipulative therapy treatment. Cardiovascular risk factors were uncommon, with the exception of diagnosed migraine. Among the participants with dissection, 67% reported transient ischemic features in the month prior to their admission for dissection. CONCLUSION: Recent minor mechanical trauma or strain to the head or neck appears to be associated with cervical arterial dissection. General cardiovascular risk factors, with the exception of migraine, were not important risk factors for dissection in this cohort. Preceding transient neurological symptoms appear to occur commonly and may assist in the identification of this serious pathology.
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| 2014 |
Thomas LC, Rivett DA, Parsons M, Levi C, 'Risk factors, radiological features, and infarct topography of craniocervical arterial dissection.', International Journal of Stroke, 9 1073-1082 (2014) [C1]
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| 2013 |
Thomas LC, Rivett DA, Bateman G, Stanwell P, Levi CR, 'Effect of Selected Manual Therapy Interventions for Mechanical Neck Pain on Vertebral and Internal Carotid Arterial Blood Flow and Cerebral Inflow', PHYSICAL THERAPY, 93 1563-1574 (2013) [C1]
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| 2012 |
Thomas L, Rivett DA, Parsons M, Levi C, 'Risk factors, radiological features and infarct topography of craniocervical arterial dissection.', International Journal of Stroke, 9 1073-1082 (2012)
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| 2012 |
Thomas L, Rivett DA, Attia JR, Levi CR, 'Risk factors and clinical presentation of craniocervical arterial dissection: A prospective study', BMC Musculoskeletal Disorders, 13 1-6 (2012) [C3]
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| 2011 |
Thomas L, Rivett DA, Attia JR, Parsons MW, Levi CR, 'Risk factors and clinical features of craniocervical arterial dissection', Manual Therapy, 16 351-356 (2011) [C1]
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| 2009 |
Thomas L, Rivett DA, Bolton PS, 'Validity of the Doppler velocimeter in examination of vertebral artery blood flow and its use in pre-manipulative screening of the neck', Manual Therapy, 14 544-549 (2009) [C1]
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| 2009 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letter to the editor', Manual Therapy, 14 E7-E8 (2009) [C3]
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| 2009 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letter to the editor by Karl et al. Manual Therapy 2009;14(6):e17', Manual Therapy, 14 E18 (2009) [C3]
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| 2008 |
Thomas L, Rivett DA, Bolton PS, 'Pre-manipulative testing and the use of the velocimeter', Manual Therapy, 13 29-36 (2008) [C1]
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| 2008 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letters to editor regarding article: Thomas LC, et al. Premanipulative testing and the velocimeter. Manual Therapy (2007)', Manual Therapy, 13 E5-E6 (2008) [C3]
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| 2005 |
Rivett DA, Thomas L, Bolton PS, 'Pre-manipulative testing: where do we go from here?', New Zealand Journal of Physiotherapy, 33 78-84 (2005) [C1]
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