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+ VBI during neck evaluation
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+ VBI during neck evaluation - July 20, 2007 9:55:13 AM
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ragempt
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From: linden, michigan
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Today I had a patient that just about past out with cervical extension and left side rotation. The room started spinning and she needed assistance in sitting. She said this dizziness started with her shoulder ache about 3 weeks ago.
I called the doctor and she recommended an MRI.
My question is why not a Dopler I thought that was the standard for + VBI
The MD said usually the dizzy is due to a stenotic condition and an MRI will show more? Will a MRI show vertebral artery entrapment in a neutral position?
Thanks evryone
Rodger
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RE: + VBI during neck evaluation - July 20, 2007 10:26:42 AM
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jma
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I would think that it would pick up the stenotic condition but not the vertebral artery entrapment in neutral.
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RE: + VBI during neck evaluation - July 20, 2007 7:03:21 PM
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jlharris
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My thoughts are that vetebral artery entrapment is not an "acute" type of problem. It's usually congenital/structural. Therefore, for it to begin with her shoulder ache would be unusual. Would assume that a stenotic condition is leading to her shoulder pain - IF the onset of each are related.
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RE: + VBI during neck evaluation - July 22, 2007 10:12:22 PM
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alodato
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Considering the hx of the shoulder ache with the sxs you describe maybe the doctor was looking for something more sinister (i.e. pancost tumor)?
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RE: + VBI during neck evaluation - July 24, 2007 8:44:12 AM
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eam
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I had a patient recently with complaints of dizziness and the MD suspected VBI and ordered an MRI and specifically asked the radiologist to comment on the patency of the arteries. Based on the report, it seems that it was picked up fine. Certainly a Doppler is quicker but in this case, perhaps an MRI would be more "all encompassing" so to speak!
Erica
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RE: + VBI during neck evaluation - July 24, 2007 9:53:21 AM
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ragempt
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not sure the cost of the dopler compared to the MRI. i would asume alot. anybody know how sensitive the dopler is for VBI? when they do a dopler for VBI do they extend and rotate the cspine?
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RE: + VBI during neck evaluation - July 24, 2007 12:54:09 PM
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Chocco
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What position did you test in ? Did the patient have dificulty with swallowong or speaking? How long were they in the test position.
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RE: + VBI during neck evaluation - July 25, 2007 9:24:02 AM
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ragempt
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Hi Chocco,
the test was done in sitting. lying made her too dizzy. she was in the position for no greater than 5 seconds and was no where near end range. no complaints of swallowing.
i know swallowing problems can be realated to anterior disc problems. is that why you asked? also from what i have been told if the patient cannot go to end range with VBI testing the test is not valid (cource i took). what are your thoughts?
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RE: + VBI during neck evaluation - July 25, 2007 9:59:55 AM
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Chocco
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Could be bppv. ( or some other vestibular disorder). Generally a + vertebral atery screen will star out more mild and progressively get worse, BPPV will start out strong right off the bat. Difficulty with speech or swalling would be present with VBA compromise, but not in a vestibular problem otherwise their symptoms could be almost identical. If the MRI comes back negative I would try doing a hallpike, and look closer at the vestibular. Best be on the safe side though, if you question VBI at all i would have it looked at.
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RE: + VBI during neck evaluation - July 25, 2007 12:00:37 PM
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ragempt
Posts: 111
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Chocco,
great feedback. i never thought of VBI getting worse with time as opposed to starting imediatly with bppv. the patient was given medication for vertigo and said her complaint are less over the last 3 weeks but not gone. do you think i jumped the gun calling the MD? the lady jumped off the bed with minimal cervical traction in supine i have never seen anything like it.
one think i should have done is turn her body on her head instead of her head on her body. this would challenge the vertebral artery while not challenging the vestib. system. darnit darnit darnit. i was more concerned about the weird dizzy stuff.
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RE: + VBI during neck evaluation - July 25, 2007 12:46:47 PM
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USAPT
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ragempt,
you were concerned for your pt, there's nothing wrong with that. Don't beat yourself up. Your correct with trying to rotate the body on head. How was the test performed in sitting..head perfectly upright and passively rotated?
have the pt sit and then slouch, this places their c-spine in backward bending, then rotate and see what happens. Just a thought.
-Jason
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RE: + VBI during neck evaluation - July 25, 2007 2:23:09 PM
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ragempt
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Jason, i had her actively rotate and extend in sitting. where were you going with the slouching? what would that rule out? othere than the slouching thats pretty much what i did except for active instaed of passive.
thanks,
R
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RE: + VBI during neck evaluation - July 25, 2007 3:36:01 PM
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Chocco
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You can also have them sit in a chair with their elbows resting on the plinth in front of them about chest height. Then have the patient bend forward at the waist and put more weight through the elbows. This also puts the c-spine in extension but keeps semicircular canals in the same plane. Then have the patient rotate their head to the side with GENTLE over pressure and you have you VBA screen. Ask the patient questions during the test and listen for change in speech, look at pts eyes, etc. If you do see positive sx in that position then don't hold them there too long, you don't want them to stroke out on you. You did do the right thing by sending him back to the doctor , If the MRI is neg you can always return to pt later and if the patient does have VBA insuficiencey, you may have saved their life.
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RE: + VBI during neck evaluation - July 25, 2007 4:04:48 PM
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ragempt
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thanks guys, this is great info. i really dont think i saved her life but am glad you guys dont totaly disagree with my thought process.
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RE: + VBI during neck evaluation - July 25, 2007 6:40:47 PM
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jlharris
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If you had to choose between VBI and BPPV which one would you like to be wrong about? The one that has a chance of killing her is the one! You did it right. I'd choose you - maybe being mistaken in this case - over any PT that would have shrugged it off and just assumed her symptoms were d/t something benign.
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Jason L. Harris, PT, DPT
My PT Blog
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RE: + VBI during neck evaluation - July 29, 2007 5:33:34 PM
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mcap56
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I am late in on this one. But, as far as I know, you are talking about two different sets of arteries. The test for the carotids in the carotid doppler. For the VBAs, the test is an MRA, not MRI although very similar.
Keep in mind that many, many patients have dizziness upon evaluation but then go onto have negative imaging. The predictive value is probably low. Also, I don't think they really do anything for VBA insufficiency outside of the usual cardiac care.
It's been a while since I looked into this. I could be completely out of date.
Marc
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RE: + VBI during neck evaluation - July 30, 2007 6:43:01 AM
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Sebastian Asselbergs
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Just testing if this site will replace the first letters of my last name with asterixes as well - asselbergs
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RE: + VBI during neck evaluation - July 30, 2007 6:44:33 AM
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Sebastian Asselbergs
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...but it leaves my user name...LOL
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